Updates from the 17th World Stroke Congress, 23rd October 2025, in Barcelona, Spain: From Alteplase to Tenecteplase for Acute Ischaemic Stroke: A Catalyst for Stroke Care Improvement
CHARLOTTE CORDONNIER,
ROBIN LEMMENS,
FRANCISCO MONICHE,
GISELE SAMPAIO SILVA
Article Information
Volume 11, Issue 2, February 2026, pages 46-54
MARTIN JAMES -Royal Devon and Exeter NHS Foundation Trust, United Kingdom;
On behalf of:
CHARLOTTE CORDONNIER -Univ Lille, Roger Salengro Hospital, France
ROBIN LEMMENS – KU Leuven, Flanders Institute for Biotechnology, Belgium
FRANCISCO MONICHE – Hospital Universitario Virgen del Rocío, Spain
GISELE SAMPAIO SILVA – Federal University of São Paulo, Brazil
Disclosures: This symposium was sponsored by Boehringer Ingelheim. Prof. Cordonnier has received consulting fees from Boehringer Ingelheim and Bayer, research contracts from the French Ministry of Health, serves on clinical trial steering committees for Bayer, Biogen, and BMS, and is an Associate Editor of Stroke journal. Prof. Lemmens reports no personal disclosures but notes institutional support from KU Leuven for speaker fees and serves on advisory boards and in consultancy roles for Bayer, Bioxodes, Boehringer Ingelheim, iSchemaView, Janssen, and Medpass. Prof. James has received consulting
fees from Boehringer Ingelheim, maintains research contracts with NIHR for health services and delivery research contracts regarding modelling of reperfusion treatments, ambulance redirection trials, and mobile stroke units, serves on clinical trial steering committees including a BHF-funded trial of early anticoagulation after ischaemic stroke, and is Trustee of the Stroke Association, a UK stroke support organisation. Dr. Moniche has received speaker fees from Boehringer Ingelheim and serves as Scientific Advisor to AbbVie, AstraZeneca, Novartis, and CellProthera. Prof. Silva serves on advisory boards for Boehringer Ingelheim and Bayer, has received funded research from Boehringer Ingelheim, Bayer, the Brazilian Ministry of Health, and the National Institutes of Health (NIH), has received honoraria and expenses from Boehringer Ingelheim and Bayer, and is an employee of the Brazilian Ministry of Health.
Abstract:
The symposium, “From Alteplase to Tenecteplase for Acute Ischaemic Stroke: A Catalyst for Stroke Care Improvement,” was delivered as a panel discussion followed by an audience Question & Answer, as part of the 17th World Stroke Congress on Thursday 23rd October 2025 in Barcelona, Spain. Acute ischaemic stroke (AIS) is a time-critical neurological emergency where every minute of delay in revascularisation leads to measurable neuronal injury and poorer outcomes. Time to treatment directly correlates with neuronal salvage and functional independence. Historically, alteplase has been the mainstay of intravenous thrombolysis, yet its short half-life, complex dosing, and risk of symptomatic intracerebral haemorrhage (sICH), have limited its use. Tenecteplase (TNK) offers comparable safety and in meta-analysis of randomised controlled trials showed superior functional outcomes, and reduced disability compared to alteplase, while providing significant operational advantages through simplified administration. Switching to TNK acts as a “catalyst” in transforming stroke care delivery, reducing door-to-needle (DTN) times, and improving workflow efficiency. Real-world data from centres that have switched support substantial reductions in DTN time after the TNK transition. Major international and national health authorities have assessed and endorsed TNK for acute ischaemic stroke. TNK represents a clinically-sound paradigm shift toward simplified, faster, and more efficient stroke workflows with the potential to save resources.
Keywords:
ALTEPLASE, ACUTE ISCHAEMIC STROKE, DOOR-TO-NEEDLE TIME, DOOR-TO-STROKE-UNIT, INTRAVENOUS THROMBOLYSIS, LARGE VESSEL OCCLUSION, MECHANICAL THROMBECTOMY, PLASMINOGEN ACTIVATOR INHIBITOR-1 (PAI-1), SYMPTOMATIC INTRACEREBRAL HAEMORRHAGE, TENECTEPLASEFollow Us
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