Grant: Project Grant

Tenecteplase is promising to replace alteplase as the clot-busting treatment of choice for patients with stroke caused by blockages of a brain artery. Some studies have already shown a higher likelihood of success in opening blocked arteries when tenecteplase is used which was almost double that of alteplase. However, the occurrence, timing and predictors of tenecteplase success are unclear. A few studies are ongoing to compare the two drugs including the Canadian, CIHR-funded Alteplase compared to Tenecteplase (AcT) trial. These studies represent an opportunity to improve the understanding of the likelihood, timing, and determinants of arterial opening with tenecteplase treatment. We designed a substudy of the AcT trial for patients who are undergoing special procedures to remove the clot (thrombectomy) to see whether blood flow was restored because of the clot-busing treatments; i.e. before clot extraction is done. Patients will not require repeat imaging beyond that already obtained during the procedure. We hope that this study will be helpful to determine which patients with acute stroke will respond to clotbusting drugs and who would require transfer for thrombectomy. We also hope that it will inform the design of future trials.