This Lancet publication addresses basilar artery occlusion, the most severe presentation of large-vessel ischemic stroke, with new randomized and observational evidence supporting intravenous tenecteplase therapy within an extended 24-hour treatment window.
Basilar artery occlusion is a devastating condition with dismal prognosis and constitutes the most severe presentation of acute ischaemic stroke due to large-vessel occlusion.1 Randomised evidence on the safety and efficacy of intravenous thrombolysis in this stroke subtype is scarce, especially outside the conventional 0–4·5 h window.1,2 Tenecteplase is a third-generation tissue plasminogen activator with higher fibrin specificity and longer half-life than alteplase.3 Accruing randomised and observational evidence supports the superiority of tenecteplase over alteplase in patients who have had an acute ischaemic stroke, particularly those with large-vessel occlusion, in improving 3-month functional outcome assessed by the modified Rankin scale (mRS) score.
