Tenecteplase Improves Reperfusion Across Time in Large Vessel Stroke

Yogendrakumar, V; Beharry, J; Churilov, L; Alidin, K; Ugalde, M; Pesavento, L; Weir, L; Mitchell, PJ; Kleinig, TJ; Yassi, N; Thijs, V; Wu, TY; Shah, DG; Dewey, HM; Wijeratne, T; Yan, B; Desmond, PM; Sharma, G; Parsons, MW; Donnan, GA; Davis, SM; Campbell, BCV

Author(s): Yogendrakumar, V; Beharry, J; Churilov, L; Alidin, K; Ugalde, M; Pesavento, L; Weir, L; Mitchell, PJ; Kleinig, TJ; Yassi, N; Thijs, V; Wu, TY; Shah, DG; Dewey, HM; Wijeratne, T; Yan, B; Desmond, PM; Sharma, G; Parsons, MW; Donnan, GA; Davis, SM; Campbell, BCV;
Details: Publication Year 2023-03,Volume 93,Issue #3,Page 489-499
Journal Title: Annals of Neurology
Abstract: BACKGROUND AND AIMS: Tenecteplase improves reperfusion compared to alteplase in patients with large vessel occlusions. To determine whether this improvement varies across the spectrum of thrombolytic to reperfusion assessment times, we performed a comparative analysis of tenecteplase and alteplase reperfusion rates. METHODS: Patients with large vessel occlusion and treatment with thrombolysis were pooled from the Melbourne Stroke Registry, the EXTEND-IA, and EXTEND-IA TNK trials. The primary outcome, thrombolytic-induced reperfusion, was defined as the absence of retrievable thrombus or >50% reperfusion at imaging reassessment. We compared the treatment effect of tenecteplase and alteplase, accounting for thrombolytic-to-assessment as exposure times, via Poisson modelling. We compared 90-day outcomes of patients who achieved reperfusion with a thrombolytic to patients who achieved reperfusion via endovascular therapy using ordinal logistic regression. RESULTS: Among 893 patients included in the primary analysis, thrombolytic-induced reperfusion was observed in 184 (21%) patients. Tenecteplase was associated with higher rates of reperfusion (adjusted incidence rate ratio [aIRR]:1.50 [95%CI:1.09-2.07], p=0.01). Findings were consistent in patient sub-groups with M1 (aIRR:1.41 [95%CI:0.93-2.14]) and M2 (aIRR:2.07 [95%CI:0.98-4.37]) occlusions. Increased thrombolytic to reperfusion assessment times were associated with reperfusion (tenecteplase: adjusted risk ratio [aRR]:1.08 per 15min [95%CI:1.04-1.13] versus alteplase: aRR:1.06 per 15min [95%CI:1.00-1.13]). No significant treatment-by-time interaction was observed (p=0.87). Reperfusion via thrombolysis was associated with improved 90-day mRS scores, (acOR:2.15 [95%CI:1.54-3.01]) compared to patients who achieved reperfusion following endovascular therapy. CONCLUSIONS: Tenecteplase, compared to alteplase, increases pre-thrombectomy reperfusion, regardless of the time from administration to reperfusion assessment. Pre-thrombectomy reperfusion is associated with better clinical outcomes. This article is protected by copyright. All rights reserved.
Publisher: Wiley
Research Division(s): Population Health And Immunity
PubMed ID: 36394101
Publisher's Version: https://doi.org/10.1002/ana.26547
Open Access at Publisher's Site: https://doi.org/10.1002/ana.26547
Terms of Use/Rights Notice: Refer to copyright notice on published article.
Documents: Annals of Neurology - 2022 - Yogendrakumar - Tenecteplase Improves Reperfusion across Time in Large Vessel Stroke.pdf - (0.28MB, application/pdf)

Creation Date: 2022-12-13 03:13:14

Last Modified: 2023-03-08 04:14:40