TRACE-5: Rethinking the 24-hour clock in Basilar Artery Occlusions
Given the favorable functional outcomes seen with Tenecteplase up to 24 hours post-symptom onset in BAO, consider aggressive workup for posterior circulation stroke even when presentation is delayed. While this suggests expanding the treatment window, remember that these results are from a specific trial design and should guide suspicion rather than abandoning established contraindications.
The TRACE-5 trial represents a significant shift in thinking regarding reperfusion therapy for basilar artery occlusion (BAO), extending the consideration window up to 24 hours from symptom onset using Tenecteplase. This large randomized study is particularly relevant because BAO management often falls outside the standard, well-defined anterior circulation thrombolysis protocols. The reported functional outcomes suggest a potential benefit with Tenecteplase even when presenting significantly later than previously thought possible for this devastating posterior circulation event. These findings strongly underscore the need for heightened suspicion and rapid evaluation of suspected BAO in the emergency department setting, regardless of the time elapsed since symptom onset.