TY - JOUR
T1 - Safety and efficacy of tenecteplase versus alteplase in stroke patients with carotid tandem lesions
T2 - Results from the AcT trial
AU - Bala, Fouzi
AU - Almekhlafi, Mohammed
AU - Singh, Nishita
AU - Alhabli, Ibrahim
AU - Ademola, Ayoola
AU - Coutts, Shelagh B.
AU - Deschaintre, Yan
AU - Khosravani, Houman
AU - Appireddy, Ramana
AU - Moreau, Francois
AU - Phillips, Stephen
AU - Gubitz, Gord
AU - Tkach, Aleksander
AU - Catanese, Luciana
AU - Dowlatshahi, Dar
AU - Medvedev, George
AU - Mandzia, Jennifer
AU - Pikula, Aleksandra
AU - Shankar, Jay
AU - Williams, Heather
AU - Field, Thalia S.
AU - Manosalva, Alejandro
AU - Siddiqui, Muzaffar
AU - Zafar, Atif
AU - Imoukhoude, Oje
AU - Hunter, Gary
AU - Benali, Faysal
AU - Horn, MacKenzie
AU - Hill, Michael D.
AU - Shamy, Michel
AU - Sajobi, Tolulope T.
AU - Buck, Brian H.
AU - Swartz, Richard H.
AU - Menon, Bijoy K.
AU - Poppe, Alexandre Y.
N1 - Publisher Copyright:
© 2023 World Stroke Organization.
PY - 2024/3
Y1 - 2024/3
N2 - Background: Carotid tandem lesions ((TL) ⩾70% stenosis or occlusion) account for 15–20% of acute stroke with large vessel occlusion. Aims: We investigated the safety and efficacy of intravenous tenecteplase (0.25 mg/kg) versus intravenous alteplase (0.9 mg/kg) in patients with carotid TL. Methods: This is a substudy of the alteplase compared with the tenecteplase trial. Patients with ⩾70% stenosis of the extracranial internal carotid artery (ICA) and concomitant occlusion of the intracranial ICA, M1 or M2 segments of the middle cerebral artery on baseline computed tomography angiography (CTA) were included. Primary outcome was 90-day-modified Rankin Scale (mRS) 0–1. Secondary outcomes were mRS 0–2, mortality, and symptomatic ICH (sICH). Angiographic outcomes were successful recanalization (revised Arterial Occlusive Lesion (rAOL) 2b–3) on first and successful reperfusion (eTICI 2b–3) on final angiographic acquisitions. Multivariable mixed-effects logistic regression was performed. Results: Among 1577 alteplase versus tenecteplase randomized controlled trial (AcT) patients, 128 (18.8%) had carotid TL. Of these, 93 (72.7%) underwent intravenous thrombolysis plus endovascular thrombectomy (IVT + EVT), while 35 (27.3%) were treated with IVT alone. In the IVT + EVT group, tenecteplase was associated with higher odds of 90-day-mRS 0–1 (46.0% vs. 32.6%, adjusted OR (aOR) 3.21; 95% CI = 1.06–9.71) compared with alteplase. No statistically significant differences in rates of mRS 0–2 (aOR 1.53; 95% CI = 0.51–4.55), initial rAOL 2b–3 (16.3% vs. 28.6%), final eTICI 2b–3 (83.7% vs. 85.7%), and mortality (18.0% vs. 16.3%) were found. SICH only occurred in one patient. There were no differences in outcomes between thrombolytic agents in the IVT-only group. Conclusion: In patients with carotid TL treated with EVT, intravenous tenecteplase may be associated with similar or better clinical outcomes, similar angiographic reperfusion rates, and safety outcomes as compared with alteplase.
AB - Background: Carotid tandem lesions ((TL) ⩾70% stenosis or occlusion) account for 15–20% of acute stroke with large vessel occlusion. Aims: We investigated the safety and efficacy of intravenous tenecteplase (0.25 mg/kg) versus intravenous alteplase (0.9 mg/kg) in patients with carotid TL. Methods: This is a substudy of the alteplase compared with the tenecteplase trial. Patients with ⩾70% stenosis of the extracranial internal carotid artery (ICA) and concomitant occlusion of the intracranial ICA, M1 or M2 segments of the middle cerebral artery on baseline computed tomography angiography (CTA) were included. Primary outcome was 90-day-modified Rankin Scale (mRS) 0–1. Secondary outcomes were mRS 0–2, mortality, and symptomatic ICH (sICH). Angiographic outcomes were successful recanalization (revised Arterial Occlusive Lesion (rAOL) 2b–3) on first and successful reperfusion (eTICI 2b–3) on final angiographic acquisitions. Multivariable mixed-effects logistic regression was performed. Results: Among 1577 alteplase versus tenecteplase randomized controlled trial (AcT) patients, 128 (18.8%) had carotid TL. Of these, 93 (72.7%) underwent intravenous thrombolysis plus endovascular thrombectomy (IVT + EVT), while 35 (27.3%) were treated with IVT alone. In the IVT + EVT group, tenecteplase was associated with higher odds of 90-day-mRS 0–1 (46.0% vs. 32.6%, adjusted OR (aOR) 3.21; 95% CI = 1.06–9.71) compared with alteplase. No statistically significant differences in rates of mRS 0–2 (aOR 1.53; 95% CI = 0.51–4.55), initial rAOL 2b–3 (16.3% vs. 28.6%), final eTICI 2b–3 (83.7% vs. 85.7%), and mortality (18.0% vs. 16.3%) were found. SICH only occurred in one patient. There were no differences in outcomes between thrombolytic agents in the IVT-only group. Conclusion: In patients with carotid TL treated with EVT, intravenous tenecteplase may be associated with similar or better clinical outcomes, similar angiographic reperfusion rates, and safety outcomes as compared with alteplase.
KW - Stroke
KW - endovascular
KW - tandem
KW - tenecteplase
UR - https://www.scopus.com/pages/publications/85173737015
U2 - 10.1177/17474930231205208
DO - 10.1177/17474930231205208
M3 - Artículo
C2 - 37731173
AN - SCOPUS:85173737015
SN - 1747-4930
VL - 19
SP - 322
EP - 330
JO - International Journal of Stroke
JF - International Journal of Stroke
IS - 3
ER -