---
title: "Baseline ASPECTS Modifies Tenecteplase Benefit Before Thrombectomy in Large‑Vessel Occlusion Stroke"
id: "pubmed-42623571"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42623571"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42623571/"
doi: "10.1212/WNL.0000000000218467"
published_at: "2026-09-22T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Baseline ASPECTS Modifies Tenecteplase Benefit Before Thrombectomy in Large‑Vessel Occlusion Stroke
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42623571
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42623571/)
- **DOI:** [10.1212/WNL.0000000000218467](https://doi.org/10.1212%2FWNL.0000000000218467)
- **Published At:** 2026-09-22T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This post hoc analysis of the BRIDGE-TNK randomized trial evaluated whether baseline ischemic extent by **ASPECTS** (Alberta Stroke Program Early Computed Tomography Score) modified the effect of intravenous **tenecteplase** given before endovascular **thrombectomy** in acute large-vessel occlusion stroke within 4.5 hours of last known well. - The analysis included 550 patients: 241 (43.8%) had ASPECTS <8 and 309 had ASPECTS 8–10. Median ages were similar across strata (69–70 years); male proportion ~56–60%. - In patients with **ASPECTS <8**, tenecteplase plus thrombectomy was associated with higher 90-day **functional independence** (mRS 0–2) compared with thrombectomy alone (adjusted risk ratio [aRR] 1.67; 95% CI 1.18–2.35). - In the ASPECTS 8–10 subgroup there was no benefit for tenecteplase on 90-day functional independence (aRR 0.99; 95% CI 0.84–1.17). - A statistically significant treatment-by-ASPECTS interaction was reported (p interaction = 0.007), indicating **baseline ischemic extent** modified the effect of tenecteplase on functional outcome. - Rates of 48-hour **symptomatic intracranial hemorrhage (sICH)** were reported as not significantly different between groups, but fuller numeric outcomes for sICH and 90-day mortality were not provided in the available source text. - This was a post hoc stratified analysis of a randomized trial conducted across China from May 2022 to September 2024; methods included regression models with a treatment-by-ASPECTS interaction term. - The source text does not report complete safety and mortality data, nor other secondary outcomes or detailed covariates and adjustments beyond the presented adjusted risk ratios and confidence intervals. - These findings suggest that patients with larger baseline ischemic injury (ASPECTS <8) may derive greater functional benefit from pre-thrombectomy **tenecteplase**, but reported data are incomplete in the abstract and further details are needed to guide practice.
## Clinical Analysis & Structured Key Points
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Epub 2026 Aug 20. # Effect of Baseline ASPECTS on Tenecteplase Efficacy Before Thrombectomy in Acute Large-Vessel Occlusion Stroke: A Post Hoc Analysis of the BRIDGE-TNK Randomized Trial [Xianjun Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+X&cauthor_id=42623571)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-1 "Department of Neurology, Yijishan Hospital of Wannan Medical University, Wuhu, China."), [Junfeng Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+J&cauthor_id=42623571)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-1 "Department of Neurology, Yijishan Hospital of Wannan Medical University, Wuhu, China."), [Jeffrey L Saver](https://pubmed.ncbi.nlm.nih.gov/?term=Saver+JL&cauthor_id=42623571)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-2 "Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA."), [Hongmei Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+H&cauthor_id=42623571)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-3 "Department of Neurology, No. 903 Hospital of PLA Joint Logistic Force, Hangzhou, China."), [Guangxiong Yuan](https://pubmed.ncbi.nlm.nih.gov/?term=Yuan+G&cauthor_id=42623571)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-4 "Department of Emergency, The Central Hospital of Xiangtan \(The Affiliated Hospital of Hunan University\), China."), [Zhenyu Kong](https://pubmed.ncbi.nlm.nih.gov/?term=Kong+Z&cauthor_id=42623571)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-5 "Department of Neurology, Jiaozuo Second People's Hospital, China."), [Zhongfan Ruan](https://pubmed.ncbi.nlm.nih.gov/?term=Ruan+Z&cauthor_id=42623571)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-6 "Department of Neurology, The First Affiliated Hospital, Hengyang Medical School, University of South China."), [Chaoqun Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+C&cauthor_id=42623571)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-7 "Department of Neurology, Xihua People's Hospital, China."), [Guangui Yang](https://pubmed.ncbi.nlm.nih.gov/?term=Yang+G&cauthor_id=42623571)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-8 "Department of Neurosurgery, Xingguo People's Hospital of Gannan Medical University, China."), [Gregory W Albers](https://pubmed.ncbi.nlm.nih.gov/?term=Albers+GW&cauthor_id=42623571)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-9 "Stanford Stroke Center, Stanford University, Palo Alto, CA."), [Thanh N Nguyen](https://pubmed.ncbi.nlm.nih.gov/?term=Nguyen+TN&cauthor_id=42623571)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-10 "Department of Neurology and Radiology, Boston Medical Center, MA."), [Hongfei Sang](https://pubmed.ncbi.nlm.nih.gov/?term=Sang+H&cauthor_id=42623571)[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-11 "Department of Neurology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, China."), [Zhongming Qiu](https://pubmed.ncbi.nlm.nih.gov/?term=Qiu+Z&cauthor_id=42623571)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-3 "Department of Neurology, No. 903 Hospital of PLA Joint Logistic Force, Hangzhou, China."), [Qingwu Yang](https://pubmed.ncbi.nlm.nih.gov/?term=Yang+Q&cauthor_id=42623571)[ 12 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-12 "Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University \(Third Military Medical University\), Chongqing, China."), [Zhiming Zhou](https://pubmed.ncbi.nlm.nih.gov/?term=Zhou+Z&cauthor_id=42623571)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-1 "Department of Neurology, Yijishan Hospital of Wannan Medical University, Wuhu, China."), [Zibao Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+Z&cauthor_id=42623571)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#full-view-affiliation-1 "Department of Neurology, Yijishan Hospital of Wannan Medical University, Wuhu, China.") Affiliations Expand ### Affiliations * 1 Department of Neurology, Yijishan Hospital of Wannan Medical University, Wuhu, China. * 2 Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA. * 3 Department of Neurology, No. 903 Hospital of PLA Joint Logistic Force, Hangzhou, China. * 4 Department of Emergency, The Central Hospital of Xiangtan (The Affiliated Hospital of Hunan University), China. * 5 Department of Neurology, Jiaozuo Second People's Hospital, China. * 6 Department of Neurology, The First Affiliated Hospital, Hengyang Medical School, University of South China. * 7 Department of Neurology, Xihua People's Hospital, China. * 8 Department of Neurosurgery, Xingguo People's Hospital of Gannan Medical University, China. * 9 Stanford Stroke Center, Stanford University, Palo Alto, CA. * 10 Department of Neurology and Radiology, Boston Medical Center, MA. * 11 Department of Neurology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, China. * 12 Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China. * PMID: **42623571** * DOI: [ 10.1212/WNL.0000000000218467 ](https://doi.org/10.1212/wnl.0000000000218467) Item in Clipboard Randomized Controlled Trial # Effect of Baseline ASPECTS on Tenecteplase Efficacy Before Thrombectomy in Acute Large-Vessel Occlusion Stroke: A Post Hoc Analysis of the BRIDGE-TNK Randomized Trial Xianjun Huang et al. Neurology. 2026. Show details Display options Display options Format Abstract PubMed PMID Neurology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Neurology%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Neurology%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42623571/) . 2026 Sep 22;107(6):e218467. doi: 10.1212/WNL.0000000000218467. Epub 2026 Aug 20. ### Authors [Xianjun Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+X&cauthor_id=42623571)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-1 "Department of Neurology, Yijishan Hospital of Wannan Medical University, Wuhu, China."), [Junfeng Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+J&cauthor_id=42623571)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-1 "Department of Neurology, Yijishan Hospital of Wannan Medical University, Wuhu, China."), [Jeffrey L Saver](https://pubmed.ncbi.nlm.nih.gov/?term=Saver+JL&cauthor_id=42623571)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-2 "Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA."), [Hongmei Xu](https://pubmed.ncbi.nlm.nih.gov/?term=Xu+H&cauthor_id=42623571)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-3 "Department of Neurology, No. 903 Hospital of PLA Joint Logistic Force, Hangzhou, China."), [Guangxiong Yuan](https://pubmed.ncbi.nlm.nih.gov/?term=Yuan+G&cauthor_id=42623571)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-4 "Department of Emergency, The Central Hospital of Xiangtan \(The Affiliated Hospital of Hunan University\), China."), [Zhenyu Kong](https://pubmed.ncbi.nlm.nih.gov/?term=Kong+Z&cauthor_id=42623571)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-5 "Department of Neurology, Jiaozuo Second People's Hospital, China."), [Zhongfan Ruan](https://pubmed.ncbi.nlm.nih.gov/?term=Ruan+Z&cauthor_id=42623571)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-6 "Department of Neurology, The First Affiliated Hospital, Hengyang Medical School, University of South China."), [Chaoqun Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+C&cauthor_id=42623571)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-7 "Department of Neurology, Xihua People's Hospital, China."), [Guangui Yang](https://pubmed.ncbi.nlm.nih.gov/?term=Yang+G&cauthor_id=42623571)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-8 "Department of Neurosurgery, Xingguo People's Hospital of Gannan Medical University, China."), [Gregory W Albers](https://pubmed.ncbi.nlm.nih.gov/?term=Albers+GW&cauthor_id=42623571)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-9 "Stanford Stroke Center, Stanford University, Palo Alto, CA."), [Thanh N Nguyen](https://pubmed.ncbi.nlm.nih.gov/?term=Nguyen+TN&cauthor_id=42623571)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-10 "Department of Neurology and Radiology, Boston Medical Center, MA."), [Hongfei Sang](https://pubmed.ncbi.nlm.nih.gov/?term=Sang+H&cauthor_id=42623571)[ 11 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-11 "Department of Neurology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, China."), [Zhongming Qiu](https://pubmed.ncbi.nlm.nih.gov/?term=Qiu+Z&cauthor_id=42623571)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-3 "Department of Neurology, No. 903 Hospital of PLA Joint Logistic Force, Hangzhou, China."), [Qingwu Yang](https://pubmed.ncbi.nlm.nih.gov/?term=Yang+Q&cauthor_id=42623571)[ 12 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-12 "Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University \(Third Military Medical University\), Chongqing, China."), [Zhiming Zhou](https://pubmed.ncbi.nlm.nih.gov/?term=Zhou+Z&cauthor_id=42623571)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-1 "Department of Neurology, Yijishan Hospital of Wannan Medical University, Wuhu, China."), [Zibao Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+Z&cauthor_id=42623571)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42623571/#short-view-affiliation-1 "Department of Neurology, Yijishan Hospital of Wannan Medical University, Wuhu, China.") ### Affiliations * 1 Department of Neurology, Yijishan Hospital of Wannan Medical University, Wuhu, China. * 2 Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA. * 3 Department of Neurology, No. 903 Hospital of PLA Joint Logistic Force, Hangzhou, China. * 4 Department of Emergency, The Central Hospital of Xiangtan (The Affiliated Hospital of Hunan University), China. * 5 Department of Neurology, Jiaozuo Second People's Hospital, China. * 6 Department of Neurology, The First Affiliated Hospital, Hengyang Medical School, University of South China. * 7 Department of Neurology, Xihua People's Hospital, China. * 8 Department of Neurosurgery, Xingguo People's Hospital of Gannan Medical University, China. * 9 Stanford Stroke Center, Stanford University, Palo Alto, CA. * 10 Department of Neurology and Radiology, Boston Medical Center, MA. * 11 Department of Neurology, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, China. * 12 Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China. * PMID: **42623571** * DOI: [ 10.1212/WNL.0000000000218467 ](https://doi.org/10.1212/wnl.0000000000218467) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background and objectives:** The impact of ischemic extent on the efficacy and safety of intravenous thrombolysis before thrombectomy remains uncertain. The aim of this study was to evaluate whether the baseline ischemic extent, measured by the Alberta Stroke Program Early Computed Tomography Score (ASPECTS), modifies outcomes of intravenous tenecteplase administered before endovascular thrombectomy. **Methods:** This was a post hoc analysis of the BRIDGE-TNK (thrombectomy with vs without rhTNK-tPA in stroke) trial, conducted across China from May 2022 to September 2024. We compared the efficacy and safety of intravenous tenecteplase plus thrombectomy vs thrombectomy alone in acute large-vessel occlusion stroke patients within 4.5 hours of last known well, stratified by baseline ASPECTS (<8 vs 8-10). The outcomes included 90-day functional independence (modified Rankin Scale score of 0-2), 48-hour symptomatic intracranial hemorrhage (sICH), and 90-day mortality. Regression models incorporating a treatment-by-ASPECTS interaction term were used for analysis. **Results:** Among 550 patients, 241 (43.8%) had ASPECTS <8 (median [interquartile range, IQR] age, 69 [61-77] years; 56.4% male) and 309 had ASPECTS 8-10 (median [IQR] age, 70 [61-77] years; 59.5% male). The rate of functional independence was significantly higher in the tenecteplase plus thrombectomy group than in the thrombectomy-alone group in the ASPECTS <8 subgroup (adjusted risk ratio [aRR], 1.67; 95% CI 1.18-2.35), but not in the ASPECTS 8-10 subgroup (aRR, 0.99; 95% CI 0.84-1.17; _p_ interaction = 0.007). Rates of sICH did not differ significantly between
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