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Minor ischemic stroke can be deceptive: a low NIHSS score does not always mean a low risk of disability, particularly when a visible intracranial occlusion is present. TEMPO-2 was a randomized phase 3 trial testing whether tenecteplase was superior to standard care in patients with minor ischemic stroke and proven occlusion or focal perfusion abnormality. The study did not demonstrate the expected clinical benefit from tenecteplase in this population and raised safety concerns. The result is important because it cautions against automatically extrapolating the benefits of thrombolysis established in more typical acute ischemic stroke populations to patients with minor deficits. For HCPs, the practical lesson is that treatment decisions should incorporate both neurological severity and vascular/imaging findings, but an apparent mismatch does not automatically justify thrombolysis. Patients with minor stroke may still require careful observation and secondary prevention because early deterioration remains possible. The trial is highly relevant to IANCON's discussion of grey zones in thrombolysis and reinforces the need for evidence specific to challenging stroke phenotypes.
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Minor ischemic stroke can be deceptive: a low NIHSS score does not always mean a low risk of disability, particularly when a visible intracranial occlusion is present. TEMPO-2 was a randomized phase 3 trial testing whether tenecteplase was superior to standard care in patients with minor ischemic stroke and proven occlusion or focal perfusion abnormality. The study did not demonstrate the expected clinical benefit from tenecteplase in this population and raised safety concerns. The result is important because it cautions against automatically extrapolating the benefits of thrombolysis established in more typical acute ischemic stroke populations to patients with minor deficits. For HCPs, the practical lesson is that treatment decisions should incorporate both neurological severity and vascular/imaging findings, but an apparent mismatch does not automatically justify thrombolysis. Patients with minor stroke may still require careful observation and secondary prevention because early deterioration remains possible. The trial is highly relevant to IANCON's discussion of grey zones in thrombolysis and reinforces the need for evidence specific to challenging stroke phenotypes.
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