There was no difference in outcome between tenecteplase and standard care for patients with mild stroke based on their baseline vessel occlusion status.
Tenecteplase showed no benefit over standard care in patients with no visible occlusion (focal perfusion abnormality only).
Tenecteplase showed no benefit over standard care in patients with near occlusion (revised arterial occlusive lesion score 1).
Tenecteplase showed no benefit over standard care in patients with complete occlusion (revised arterial occlusive lesion score 0).
The study population of 881 patients was divided into three subgroups based on baseline vessel occlusion status.
There were baseline imbalances between treatment arms within some occlusion subgroups.
The overall TEMPO-2 trial enrolled patients with minor ischaemic stroke (NIHSS ≤ 5) and intracranial occlusion or focal perfusion abnormality within 12 hours of onset.
This research examined whether a clot-dissolving drug called tenecteplase might benefit certain subgroups of patients who had mild strokes, specifically based on how severely the blood vessels in their brain were blocked. The TEMPO-2 trial had already shown that tenecteplase did not help mild stroke patients overall compared to standard care, but researchers wondered if patients with different degrees of vessel blockage — complete occlusion, near-occlusion, or no visible blockage but abnormal blood flow — might respond differently to the treatment. Among 881 patients divided into these three groups, the study found no meaningful difference in outcomes between tenecteplase and standard care in any of the subgroups. Whether patients had a completely blocked vessel, a nearly blocked vessel, or just abnormal blood flow without a visible clot, tenecteplase did not improve the likelihood of returning to their pre-stroke level of functioning at 90 days. This research suggests that the degree of vessel blockage at the time of treatment does not identify a subgroup of mild stroke patients who would benefit from tenecteplase. This adds to existing evidence that thrombolytic therapy with tenecteplase may not be the right approach for patients with mild strokes, regardless of their imaging findings, and highlights the ongoing challenge of finding effective treatments for this common and clinically important patient population.
Räty S, Strbian D, Singh N, Vatanpour S, Tomppo L, Ganesh A, et al.. (2026). Tenecteplase versus standard care for minor ischaemic stroke according to the baseline occlusion status in TEMPO-2 trial.. European stroke journal. https://doi.org/10.1093/esj/aakag111