Thrombolysis for acute ischemic stroke has predominantly been with alteplase for over a quarter of a century. In recent years, with trials showing evidence of higher rates of successful reperfusion, similar safety profile and efficacy of tenecteplase (TNK) as compared to alteplase, TNK has now emerged as another potential choice for thrombolysis in acute ischemic stroke. In this review, we will focus on these recent advances, aiming: (1) to provide a brief overview of thrombolysis in stroke; (2) to provide comparisons between alteplase and TNK for clinical, imaging, and safety outcomes; (3) to focus on key subgroups of interest to understand if there is an advantage of using TNK over alteplase or vice-versa, to review available evidence on role of TNK in intra-arterial thrombolysis, as bridging therapy and in mobile stroke units; and (4) to summarize what to expect in the near future from recently completed trials and propose areas for future research on this evolving topic. We present compelling data from several trials regarding the safety and efficacy of TNK in acute ischemic stroke along with completed yet unpublished trials that will help provide insight into these unanswered questions.

中文翻译：

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用替奈普酶替代阿替普酶：时机成熟了吗？

超过四分之一个世纪以来，急性缺血性中风的溶栓治疗主要使用阿替普酶。近年来，随着试验显示替奈普酶 (TNK) 与阿替普酶相比具有更高的成功再灌注率、相似的安全性和疗效的证据，TNK 现在已成为急性缺血性卒中溶栓的另一种潜在选择。在这篇综述中，我们将重点关注这些最新进展，旨在：(1) 简要概述卒中溶栓治疗；(2) 比较阿替普酶和 TNK 的临床、影像学和安全结果；(3) 关注感兴趣的关键亚组，以了解使用 TNK 是否优于阿替普酶，反之亦然，审查有关 TNK 在动脉内溶栓、桥接治疗和移动卒中单元中作用的现有证据；(4) 总结最近完成的试验在不久的将来会发生什么，并就这一不断发展的主题提出未来研究的领域。我们提供了来自几项关于 TNK 治疗急性缺血性卒中的安全性和有效性的试验的令人信服的数据，以及有助于深入了解这些悬而未决的问题的已完成但未发表的试验。