Objective To compare the effects of intravenous thrombolysis with tenecteplase combined with endovascular treatment versus alteplase combined with endovascular treatment in patients with acute ischemic stroke (AIS).

Methods A total of 98 patients with AIS in the hospital from January 2021 to October 2022 were randomly divided into alteplase group and tenecteplase group, with 49 cases in each group. The alteplase group received alteplase thrombolysis combined with endovascular treatment, while the tenecteplase group received tenecteplase combined with endovascular treatment. General clinical materials were compared between the two groups; the National Institutes of Health Stroke Scale (NIHSS) scores at baseline (T₀), 1 hour after thrombolysis (T₁), 24 hours after endovascular treatment (T₂), 7 days after endovascular treatment (T₃), and at discharge (T₄) were compared between two groups; the modified Rankin Scale (mRS) scores and Barthel index (BI) scores at T₀, 30 days after endovascular treatment (T₅), and 90 days after endovascular treatment (T₆) were also compared between two groups; the length of hospital stay, occurrence of complications, and clinical efficacy were compared between the two groups.

Results There were no significant differences in age, gender distribution, body mass index (BMI), hypertension, diabetes, coronary heart disease, smoking, alcoholism, cerebral infarction volume, infarction location, and clinical classification between the two groups (P>0.05). Compared with the alteplase group, the NIHSS scores at T₁, T₂, T₃ and T₄ were significantly lower in the tenecteplase group (P < 0.05). Similarly, the mRS scores at T₅ and T₆ were significantly lower while the BI scores at T₅ and T₆ were significantly higher in the tenecteplase group than the alteplase group (P < 0.05). The length of hospital stay was significantly shorter in the tenecteplase group than the alteplase group (P < 0.05). The incidence rates of post-treatment complications such as cerebral hemorrhage, gastrointestinal bleeding, skin and oral mucosa bleeding, atrial fibrillation, and hypotension in the alteplase group were 10.20%, 2.04%, 8.16%, 0%, and 8.16% respectively, while those in the tenecteplase group were 2.04%, 4.08%, 6.12%, 2.04%, and 4.08% respectively; the incidence rate of cerebral hemorrhage in the tenecteplase group was significantly lower than the alteplase group (P < 0.05). The total effective rate was 85.71% in the alteplase group, which was significantly lower than the 91.84% in the tenecteplase group (P < 0.05).

Conclusion Compared with alteplase bridging therapy, tenecteplase bridging therapy shows better clinical outcomes, which can improve the quality of life and prognosis of patients with AIS to a certain extent, reduce the probability of cerebral hemorrhage, and enhance clinical efficacy.