SynthesisBrain and behavior2026
Comparative Effectiveness of Intravenous Tenecteplase versus Alteplase in Posterior Circulation Ischemic Stroke: A Systematic Review and Meta-Analysis.
Synthesis in Brain and behavior, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
12 authors.
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Abstract
backgroundPosterior circulation ischemic stroke (PCIS) is associated with substantial morbidity and mortality, and the optimal intravenous thrombolytic strategy in this subgroup remains unclear.
methodsWe searched databases for studies comparing intravenous tenecteplase with alteplase in adults with PCIS. The primary outcome was functional independence at 90 days (mRS 0-2). Secondary outcomes included other functional outcomes, reperfusion, hemorrhagic complications, and mortality.
resultsFive studies involving 997 patients were included. Regarding efficacy outcomes, tenecteplase was associated with a significantly greater likelihood of achieving an ambulatory functional outcome at 90 days (mRS 0-3) [RR 1.29, 95% CI 1.03-1.60; p = 0.02] and improved pre-EVT perfusion [RR 2.18, 95% CI 1.06-4.46; p = 0.03]. No significant differences were observed for excellent functional outcome (mRS 0-1) [RR 1.19, 95% CI 0.91-1.56; p = 0.20], functional independence (mRS 0-2) [RR 1.10, 95% CI 0.89-1.37; p = 0.39], or post-EVT perfusion [RR 1.12, 95% CI 0.89-1.40; p = 0.34]. Regarding safety outcomes, no significant differences were observed between tenecteplase and alteplase for symptomatic intracranial hemorrhage (sICH) [RR 0.89, 95% CI 0.36-2.22; p = 0.81], any intracranial hemorrhage [RR 1.02, 95% CI 0.59-1.78; p = 0.94], parenchymal hematoma [RR 0.76, 95% CI 0.24-2.38; p = 0.64], or 90-day mortality [RR 0.88, 95% CI 0.66-1.17; p = 0.39].
conclusionTenecteplase may improve reperfusion and ambulatory recovery without increasing hemorrhagic complications or mortality compared with alteplase in PCIS, although larger PCIS-specific studies are needed.
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