Quick answer
Basilar artery occlusion is the most lethal form of ischaemic stroke: without recanalisation, roughly 90% of patients are left disabled or die. Thrombectomy is the default when a patient reaches a centre that can do it, but many do not, and many arrive late. TRACE-5, led by Wang Yongjun at Beijing Tiantan Hospital across 66 Chinese centres, asked whether intravenous tenecteplase helps within 24 hours. It did: good functional outcome at 90 days rose from 28% to 37.6%, with no significant increase in mortality or symptomatic intracranial haemorrhage. The trial was published in The Lancet on 5 February 2026 [1][3][5].
Key takeaways
- Design: multicentre, prospective, randomised, open-label, blinded-endpoint, superiority phase 3 trial at 66 Chinese stroke centres [2][5].
- Population: 452 patients with basilar artery occlusion within 24 hours of onset or last known well, including wake-up and unwitnessed strokes [5].
- Dose: tenecteplase 0.25 mg/kg to a maximum of 25 mg [5].
- Primary outcome: 90-day mRS 0–1 or return to baseline in 37.6% versus 28% [5][6].
- Safety: no significant difference in 90-day mortality or 36-hour symptomatic intracranial haemorrhage [3][6].
Why the control arm matters
Both arms could receive endovascular treatment, and the control arm was allowed to use alteplase where indicated. That design reflects real practice rather than a laboratory comparison: the question was whether adding tenecteplase before or instead of standard care improves outcomes, not whether thrombolysis beats placebo [3][4].
It also follows a programme. In 2024 the same group published TRACE-III in the New England Journal of Medicine, extending tenecteplase to 24 hours in anterior-circulation large-vessel occlusion. TRACE-5 extends the same question to the posterior circulation, where the risk of bleeding is different and the consequences of occlusion are more catastrophic [2].
Reading a 9.6-point gain
An absolute increase of roughly ten percentage points in independent function is substantial for a condition in which most patients are otherwise left severely disabled. The absence of excess mortality and haemorrhage is what makes the result usable, because posterior-circulation strokes carry a high bleeding risk when reperfused [3][5].
Outcome assessors were blinded but treating clinicians were not, which is the accepted standard for thrombolysis trials but still a design limitation. The trial enrolled patients eligible for intravenous thrombolysis with pre-stroke mRS ≤3, so the frailest patients were excluded. Sample size of 452 across 66 centres means about seven patients per centre on average — a reminder that the result depends on protocol discipline rather than individual volume. Longer-term and quality-of-life data will follow [5][6].
The condition in context: basilar occlusion
Posterior-circulation stroke is less common than anterior but far more often fatal.
| Region | What the data shows | Source |
|---|---|---|
| Prognosis | Without recanalisation, about 90% of patients are disabled or die [1][2]. | Tiantan / Capital Medical University [1][2] |
| Prior evidence | Late-window thrombolysis evidence for this territory was lacking before TRACE-5 [2]. | Capital Medical University [2] |
| Guidelines | Guidelines already suggest thrombolysis up to 24 hours in eligible patients without contraindications [4]. | Tencent News / Lancet interview [4] |
Because many basilar occlusions present with fluctuating symptoms and delayed diagnosis, an extended window has more practical relevance here than in anterior stroke [1][5].
Why it matters
| Potential | What the report suggests | Source |
|---|---|---|
| New option | Thrombolysis extended to 24 hours for basilar occlusion [2][5]. | [2][5] |
| Effect size | 37.6% versus 28% independent at 90 days [5]. | [5] |
| Caution | Open-label; selected population [6]. | [6] |
Availability and limits
- This is an editorial summary of the publication, not a treatment recommendation [1][5].
- Eligibility requires basilar occlusion confirmed on imaging within 24 hours [5].
- Patients with pre-stroke disability above mRS 3 were excluded [5].
- Open-label design; long-term functional data still maturing [6].
- Access depends on a stroke centre able to image and treat urgently [1].
What to ask before booking
| Question | Why it matters |
|---|---|
| Is the occlusion basilar, and how long since onset? | Both determine eligibility for the 24-hour window [5]. |
| Is thrombectomy available here? | It remains the default where feasible [3]. |
| Which department handles foreign patients, and in what language? | Tiantan is a working hospital we do not book; confirm international-department coordination and language support. |
| What is my bleeding risk profile? | Reperfusion in the posterior circulation carries specific risk [6]. |
Questions patients ask
What did TRACE-5 test?
Intravenous tenecteplase versus standard medical treatment within 24 hours of basilar artery occlusion, in a multicentre randomised phase 3 trial at 66 Chinese centres [2][5].
What was the result?
90-day independent outcome (mRS 0–1 or back to baseline) was 37.6% with tenecteplase versus 28% with standard treatment [5].
Was it safe?
No significant difference in 90-day mortality or 36-hour symptomatic intracranial haemorrhage [3][6].
Where was it published?
The Lancet, online 5 February 2026, and presented at the International Stroke Conference [1][2].
Is this relevant to international patients?
It is useful context for stroke care in China. Tiantan is a working hospital we do not book — contact its international department directly [1].