Tenecteplase versus alteplase before stroke thrombectomy: outcomes after system-wide transitions in Pennsylvania

Philipp Hendrix, Bradley A. Gross, Sepideh Allahdadian, Georgios S. Sioutas, Prateeka Koul, Antonio Corral Tarbay, Michael J. Lang, Visish M. Srinivasan, Alhamza R. Al-Bayati, Jiang Li, Anthony Noto, Raul G. Nogueira, Jan Karl Burkhardt, Ramin Zand, Clemens M. Schirmer

Research output: Contribution to journalComment/debatepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)5637-5641
Number of pages5
JournalJournal of Neurology
Volume271
Issue number8
DOIs
StatePublished - Aug 2024

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

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