TY - JOUR
T1 - Tenecteplase versus alteplase before stroke thrombectomy
T2 - outcomes after system-wide transitions in Pennsylvania
AU - Hendrix, Philipp
AU - Gross, Bradley A.
AU - Allahdadian, Sepideh
AU - Sioutas, Georgios S.
AU - Koul, Prateeka
AU - Tarbay, Antonio Corral
AU - Lang, Michael J.
AU - Srinivasan, Visish M.
AU - Al-Bayati, Alhamza R.
AU - Li, Jiang
AU - Noto, Anthony
AU - Nogueira, Raul G.
AU - Burkhardt, Jan Karl
AU - Zand, Ramin
AU - Schirmer, Clemens M.
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/8
Y1 - 2024/8
N2 - Introduction: United States stroke systems are increasingly transitioning from alteplase (TPA) to tenecteplase (TNK). Real-world data on the safety and effectiveness of replacing TPA with TNK before large vessel occlusion (LVO) stroke endovascular treatment (EVT) are lacking. Methods: Four Pennsylvania stroke systems transitioned from TPA to TNK during the study period 01/2020–06/2023. LVO stroke patients who received intravenous thrombolysis with TPA or TNK before EVT were reviewed. Multivariate logistic analysis was conducted adjusting for age, sex, National Institute of Health Stroke Scale (NIHSS), occlusion site, last-known-well-to-intravenous thrombolysis time, interhospital-transfer and stroke system. Results: Of 635 patients, 309 (48.7%) received TNK and 326 (51.3%) TPA prior to EVT. The site of occlusion was the M1 middle cerebral artery (MCA) (47.7%), M2 MCA (25.4%), internal carotid artery (14.0%), tandem carotid with M1 or M2 MCA (9.8%) and basilar artery (3.1%). A favorable functional outcome (90-day mRS ≤ 2) was observed in 47.6% of TNK and 49.7% of TPA patients (p = 0.132). TNK versus TPA groups had similar rates of early recanalization (11.9% vs. 8.4%, p = 0.259), successful endovascular reperfusion (93.5% vs. 89.3%, p = 0.627), symptomatic intracranial hemorrhage (3.2% vs. 3.4%, p = 0.218) and 90-day all-cause mortality (23.1% vs. 21.5%, p = 0.491). Conclusions: This U.S. multicenter real-world clinical experience demonstrated that switching from TPA to TNK before EVT for LVO stroke resulted in similar endovascular reperfusion, safety, and functional outcomes.
AB - Introduction: United States stroke systems are increasingly transitioning from alteplase (TPA) to tenecteplase (TNK). Real-world data on the safety and effectiveness of replacing TPA with TNK before large vessel occlusion (LVO) stroke endovascular treatment (EVT) are lacking. Methods: Four Pennsylvania stroke systems transitioned from TPA to TNK during the study period 01/2020–06/2023. LVO stroke patients who received intravenous thrombolysis with TPA or TNK before EVT were reviewed. Multivariate logistic analysis was conducted adjusting for age, sex, National Institute of Health Stroke Scale (NIHSS), occlusion site, last-known-well-to-intravenous thrombolysis time, interhospital-transfer and stroke system. Results: Of 635 patients, 309 (48.7%) received TNK and 326 (51.3%) TPA prior to EVT. The site of occlusion was the M1 middle cerebral artery (MCA) (47.7%), M2 MCA (25.4%), internal carotid artery (14.0%), tandem carotid with M1 or M2 MCA (9.8%) and basilar artery (3.1%). A favorable functional outcome (90-day mRS ≤ 2) was observed in 47.6% of TNK and 49.7% of TPA patients (p = 0.132). TNK versus TPA groups had similar rates of early recanalization (11.9% vs. 8.4%, p = 0.259), successful endovascular reperfusion (93.5% vs. 89.3%, p = 0.627), symptomatic intracranial hemorrhage (3.2% vs. 3.4%, p = 0.218) and 90-day all-cause mortality (23.1% vs. 21.5%, p = 0.491). Conclusions: This U.S. multicenter real-world clinical experience demonstrated that switching from TPA to TNK before EVT for LVO stroke resulted in similar endovascular reperfusion, safety, and functional outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85197936737&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85197936737&partnerID=8YFLogxK
U2 - 10.1007/s00415-024-12530-x
DO - 10.1007/s00415-024-12530-x
M3 - Comment/debate
C2 - 38960948
AN - SCOPUS:85197936737
SN - 0340-5354
VL - 271
SP - 5637
EP - 5641
JO - Journal of Neurology
JF - Journal of Neurology
IS - 8
ER -