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News
For stroke patients with basilar artery occlusion treated 4.5–24 hours after symptom onset, adding IV tenecteplase before endovascular thrombectomy (EVT) offered no extra benefit over EVT alone. The ATTENTION LATE trial found nearly identical rates of functional independence, mortality, and brain bleeding between the two groups. Clinicians are advised to keep treatment decisions individualized.
For patients with basilar artery occlusion (BAO) — a rare but severe form of stroke — getting to the cath lab quickly is already the gold standard. But a lingering question has been whether giving a clot-busting drug (tenecteplase) intravenously before endovascular thrombectomy (EVT) adds any benefit, especially when patients arrive late (4.5–24 hours after stroke onset). The ATTENTION LATE trial, published in JAMA, now has an answer: probably not.
The multicenter randomized trial enrolled 330 adults across 40 centers in China. Patients either received IV tenecteplase followed by EVT or EVT alone. Across the board — functional independence, mortality, and symptomatic brain bleeding — outcomes were nearly identical between groups. Experts note the findings are specific to this late-window, moderate-to-severe BAO population and may not fully translate to Western patients, who tend to have more cardioembolic strokes rather than large-artery atherosclerosis.
By the Numbers:
Why it matters: This trial gives clinicians clearer guidance for a tricky clinical scenario — late-presenting BAO patients heading to EVT. The takeaway: skip the pre-EVT thrombolytic in this window, unless EVT is delayed or unavailable.
