TY - JOUR
T1 - Basilar Artery Occlusion Stroke Managed With Tenecteplase Versus Alteplase Before Endovascular Treatment (BAO-TNK)
AU - Karamchandani, Rahul R.
AU - Wolman, Dylan N.
AU - Bielinski, Tyler M.
AU - Goyal, Nitin
AU - Rhoten, Jeremy B.
AU - Jayaraman, Mahesh V.
AU - Sidebottom, Christian T.
AU - Gross, Bradley A.
AU - Al-Bayati, Alhamza R.
AU - Doheim, Mohamed F.
AU - Tobin, Matthew K.
AU - Chinthala, Anoop
AU - Gajjar, Avi
AU - Mascitelli, Justin
AU - Webb, Matthew R.
AU - Burkhardt, Jan Karl
AU - Scott, Kyle W.
AU - Srinivasan, Visish
AU - Tonetti, Daniel
AU - Koneru, Manisha
AU - Altschul, David J.
AU - Vaishnav, Dhrumhil
AU - Multani, Sumeet
AU - Theofanis, Thana
AU - Ares, William J.
AU - Sone, Je Yeong
AU - Zand, Ramin
AU - Bahrami, Sasan
AU - Li, Jiang
AU - Defilipp, Gary
AU - Strong, Dale
AU - Torabi, Radmehr
AU - Moldovan, Krisztina
AU - Kline, Kelsey E.
AU - Schirmer, Clemens M.
AU - Nogueira, Raul G.
AU - Paul, Alexandra R.
AU - Bohnstedt, Bradley N.
AU - Hendrix, Philipp
N1 - Publisher Copyright:
© 2025 The Author(s). Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.
PY - 2025
Y1 - 2025
N2 - Objective: To compare the effectiveness and safety of tenecteplase (TNK) versus alteplase (TPA) in patients with basilar artery occlusion prior to endovascular treatment (EVT). Methods: In this retrospective multicenter study (BAO-TNK), we analyzed consecutive BAO patients from 14 U.S. stroke systems who received TNK or TPA within 4.5 h of last known well and were referred for EVT (01/2020-08/2024). Multivariable logistic regression models were adjusted for age, sex, NIH Stroke Scale (NIHSS), posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), last-known-well-to-door time, and stroke etiology. Outcomes included 90-day modified Rankin Scale (mRS), reperfusion rates, and intracranial hemorrhage (ICH) per Heidelberg classification. Results: Of 163 BAO patients, 75 (46.0%) received TNK and 88 (54.0%) received TPA. Rates of 90-day good functional outcome (mRS 0–3) were comparable between groups (TNK: 61.8% vs. TPA: 48.8%, adjusted odds ratio [aOR] 1.372, 95% CI 0.616–3.054, p = 0.439). No significant differences were observed in rates of pre-thrombectomy early reperfusion (18.7% vs. 14.8%, aOR 0.933, 95% CI 0.369–2.359, p = 0.884), post-thrombectomy final reperfusion (97.3% vs. 92.0%, aOR 2.133, 95% CI 0.376–12.116, p = 0.393), 90-day mortality (32.4% vs. 39.5%, aOR 0.989, 95% CI 0.436–2.244, p = 0.979), or symptomatic ICH (4.0% vs. 4.5%, aOR 1.319, 95% CI 0.245–7.114, p = 0.747). Predictors of favorable outcome included younger age, lower NIHSS, higher pc-ASPECTS, shorter LKW-to-puncture time, and non-atherothrombotic stroke etiology. Interpretation: In BAO stroke, TNK and TPA administered within 4.5 h pre-EVT were associated with similar functional outcomes, reperfusion success and hemorrhage rates.
AB - Objective: To compare the effectiveness and safety of tenecteplase (TNK) versus alteplase (TPA) in patients with basilar artery occlusion prior to endovascular treatment (EVT). Methods: In this retrospective multicenter study (BAO-TNK), we analyzed consecutive BAO patients from 14 U.S. stroke systems who received TNK or TPA within 4.5 h of last known well and were referred for EVT (01/2020-08/2024). Multivariable logistic regression models were adjusted for age, sex, NIH Stroke Scale (NIHSS), posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), last-known-well-to-door time, and stroke etiology. Outcomes included 90-day modified Rankin Scale (mRS), reperfusion rates, and intracranial hemorrhage (ICH) per Heidelberg classification. Results: Of 163 BAO patients, 75 (46.0%) received TNK and 88 (54.0%) received TPA. Rates of 90-day good functional outcome (mRS 0–3) were comparable between groups (TNK: 61.8% vs. TPA: 48.8%, adjusted odds ratio [aOR] 1.372, 95% CI 0.616–3.054, p = 0.439). No significant differences were observed in rates of pre-thrombectomy early reperfusion (18.7% vs. 14.8%, aOR 0.933, 95% CI 0.369–2.359, p = 0.884), post-thrombectomy final reperfusion (97.3% vs. 92.0%, aOR 2.133, 95% CI 0.376–12.116, p = 0.393), 90-day mortality (32.4% vs. 39.5%, aOR 0.989, 95% CI 0.436–2.244, p = 0.979), or symptomatic ICH (4.0% vs. 4.5%, aOR 1.319, 95% CI 0.245–7.114, p = 0.747). Predictors of favorable outcome included younger age, lower NIHSS, higher pc-ASPECTS, shorter LKW-to-puncture time, and non-atherothrombotic stroke etiology. Interpretation: In BAO stroke, TNK and TPA administered within 4.5 h pre-EVT were associated with similar functional outcomes, reperfusion success and hemorrhage rates.
UR - https://www.scopus.com/pages/publications/105021879283
UR - https://www.scopus.com/pages/publications/105021879283#tab=citedBy
U2 - 10.1002/acn3.70240
DO - 10.1002/acn3.70240
M3 - Article
C2 - 41236051
AN - SCOPUS:105021879283
SN - 2328-9503
JO - Annals of Clinical and Translational Neurology
JF - Annals of Clinical and Translational Neurology
ER -