Tenecteplase shows improved 90-day functional outcomes compared to alteplase in distal (M3 and beyond) middle cerebral artery occlusions.
Distinct efficacy signals observed in distal M2 and anterior cerebral artery occlusions favor tenecteplase, though not reaching statistical significance.
No significant differences were found in proximal M2 or posterior cerebral artery occlusions, or across ischemic core and perfusion profiles.
Findings support expanding tenecteplase use beyond large and medium vessel occlusions to include distal cerebral artery stroke subtypes.
