- Design
- Multicentre, open-label, blinded-endpoint randomised trial
- Population
- 330 patients with basilar occlusion, NIHSS 10 or more, 4.5-24 h from onset
- Primary outcome
- Modified Rankin 0-2 at 90 days
- Effect
- 30% vs 30%; adjusted RR 0.92 (95% CI 0.67 to 1.25)
ATTENTION LATE, an open-label, blinded-endpoint randomised trial in JAMA (23 September 2026), enrolled 330 patients at 40 Chinese stroke centres with moderate to severe basilar artery occlusion (NIHSS 10 or more) arriving 4.5 to 24 hours after onset. They received tenecteplase 0.25 mg/kg before thrombectomy, or thrombectomy alone.
Functional independence at 90 days (modified Rankin 0-2) was 30% in both groups (adjusted rate ratio 0.92, 95% CI 0.67 to 1.25). Symptomatic haemorrhage was 5% against 4%, and 90-day mortality 40% against 43%.
Patients were admitted directly to thrombectomy-capable centres, so the trial does not address whether thrombolysis helps when transfer delays thrombectomy. It is one trial of 330, and wide enough to miss a modest effect.
For the clinician without a stroke background, the lesson is the one that matters: in late basilar occlusion, the priority is getting the patient to thrombectomy, not adding a lytic on the way.
- Think of basilar occlusion in any patient with sudden reduced consciousness, vertigo with cranial nerve signs, or quadriparesis
- Refer late-presenting basilar occlusion urgently for thrombectomy; time spent on thrombolysis bought nothing here
- Do not assume a patient is outside a treatment window at 4.5 hours — thrombectomy is still offered up to 24 hours
- Mortality was about four in ten in both groups — discuss prognosis early with families
Why it matters
It removes one step from the late basilar pathway and puts the emphasis back on speed to the angiography suite.
Don't overread it
It tested direct admission to thrombectomy centres; it cannot answer whether thrombolysis helps before a long transfer.
The statistics, in plain English
A rate ratio of 0.92 with an interval of 0.67 to 1.25 means the data fit anything from a third fewer to a quarter more independent patients with tenecteplase — no demonstrated benefit, but not precise enough to exclude a modest one.
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