JAMA

ISC 2026: Tenecteplase extends treatment window for non-large vessel stroke

February 11, 2026

Presented at the International Stroke Conference, the OPTION trial (NCT05752916) showed that tenecteplase significantly improves excellent functional outcomes (modified Rankin Scale 0-1) in patients with acute ischemic stroke without large vessel occlusion (LVO) treated 4.5 to 24 hours after onset.

The multicenter randomized trial enrolled 566 patients with favorable perfusion imaging profiles and non-LVO stroke. At 90 days, 43.6% of tenecteplase-treated patients achieved excellent outcomes vs. 34.2% receiving standard care. However, symptomatic intracranial hemorrhage occurred more frequently with tenecteplase (2.8% vs. 0%).

Clinical takeaway: In carefully selected non‑LVO stroke patients with salvageable tissue, late‑window tenecteplase may improve outcomes, but this benefit should be weighed against increased bleeding risk.

Source:

Ma G, et al; OPTION Investigators. (2026, February 5). JAMA. Tenecteplase for Acute Non-Large Vessel Occlusion 4.5 to 24 Hours After Ischemic Stroke: The OPTION Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/41642827/