Intravenous tenecteplase before endovascular thrombectomy in patients with acute basilar artery occlusion within 4.5–24 hours: study protocol and rationale

Background and purpose One clinical trial demonstrated the beneficial effect of intravenous tenecteplase for large vessel occlusion patients not undergoing endovascular thrombectomy (EVT) within 4.5–24 hours. However, for those with acute basilar artery occlusion (BAO) presenting beyond the 4.5-hour therapeutic window, it remains unknown whether intravenous thrombolysis before EVT is beneficial. This study hypothesised that treatment of acute BAO patients with intravenous tenecteplase before EVT will result in better clinical outcomes vs EVT alone within 4.5–24 hours. Methods and design ATTENTION LATE is a prospective, multicentre, randomised, controlled, open-label trial with blinded endpoint assessment. This study will enrol patients with acute BAO who present within 4.5–24 hours of symptom onset. These patients will be randomised 1:1 to either intravenous tenecteplase bridging to EVT or EVT alone. Study outcomes A score of 0–2 on the modified Rankin Scale at 90 days will serve as the primary endpoint. Discussion The ATTENTION LATE trial evaluates whether administering intravenous tenecteplase is safe and effective for acute BAO patients prior to EVT beyond the 4.5-hour time frame. This trial could establish the basis for expanding the eligible patient population to receive intravenous thrombolysis and extending the time window for acute BAO. Trial registration number NCT05701956 .