Tenecteplase versus alteplase before endovascular therapy in basilar artery occlusion

Alemseged, F; Ng, FC; Williams, C; Puetz, V; Boulouis, G; Kleinig, TJ; Rocco, A; Wu, TY; Shah, D; Arba, F; Kaiser, D; Di Giuliano, F; Morotti, A; Sallustio, F; Dewey, HM; Bailey, P; O&#39;Brien, B; Sharma, G; Bush, S; Dowling, R; Diomedi, M; Churilov, L; Yan, B; Parsons, MW; Davis, SM; Mitchell, PJ; Yassi, N; Campbell, BCV; BATMAN Study Group,; EXTEND IA TNK Study Group,

Author(s): Alemseged, F; Ng, FC; Williams, C; Puetz, V; Boulouis, G; Kleinig, TJ; Rocco, A; Wu, TY; Shah, D; Arba, F; Kaiser, D; Di Giuliano, F; Morotti, A; Sallustio, F; Dewey, HM; Bailey, P; O'Brien, B; Sharma, G; Bush, S; Dowling, R; Diomedi, M; Churilov, L; Yan, B; Parsons, MW; Davis, SM; Mitchell, PJ; Yassi, N; Campbell, BCV; BATMAN Study Group,; EXTEND IA TNK Study Group,;
Details: Publication Year 2021-01-06,Volume 96,Issue #9,Page e1272-e1277
Journal Title: Neurology
Publication Type: epub ahead of print
Abstract: OBJECTIVE: To investigate the efficacy of tenecteplase (TNK), a genetically modified variant of alteplase with greater fibrin specificity and longer half-life than alteplase, prior to endovascular thrombectomy (EVT) in patients with basilar artery occlusion (BAO). METHODS: To determine whether tenecteplase is associated with better reperfusion rates than alteplase prior to EVT in BAO, clinical and procedural data of consecutive BAO patients from the Basilar Artery Treatment and MANagement (BATMAN) registry and the Tenecteplase versus Alteplase before Endovascular Therapy for Ischemic Stroke (EXTEND-IA TNK) trial were retrospectively analyzed. Reperfusion >50% or absence of retrievable thrombus at the time of the initial angiogram was evaluated. RESULTS: We included 110 BAO patients treated with intravenous thrombolysis prior to EVT [mean age 69(SD 14); median NIHSS 16(IQR 7-32)]. Nineteen patients were thrombolysed with TNK (0.25mg/kg or 0.40mg/kg) and 91 with alteplase (0.9mg/kg). Reperfusion>50% occurred in 26% (n=5/19) of patients thrombolysed with TNK vs 7% (n=6/91) thrombolysed with alteplase (RR 4.0 95%CI 1.3-12; p=0.02), despite shorter thrombolysis-to-arterial-puncture time in the TNK-treated patients (48[IQR 40-71]mins) vs alteplase-treated patients (110[IQR 51-185]mins, p=0.004). No difference in symptomatic intracranial hemorrhage was observed (0/19(0%) TNK, 1/91(1%) alteplase, p=0.9). CONCLUSIONS: Tenecteplase may be associated with an increased rate of reperfusion in comparison with alteplase before EVT in BAO. Randomized controlled trials to compare tenecteplase with alteplase in BAO patients are warranted. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that tenecteplase leads to higher reperfusion rates in comparison with alteplase prior to EVT in BAO patients.
Publisher: Am Acad Neurol
Research Division(s): Population Health And Immunity
PubMed ID: 33408145
Publisher's Version: https://doi.org/10.1212/wnl.0000000000011520
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2021-03-09 08:05:44

Last Modified: 2021-03-09 08:31:32