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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Tenecteplase Improves Reperfusion across Time in Large Vessel Stroke.
Vignan Yogendrakumar1, James Beharry1,2, Leonid Churilov1
1Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
Annals of Neurology
|November 17, 2022
Summary
Tenecteplase significantly improves reperfusion rates in stroke patients compared to alteplase, regardless of assessment time. This enhanced reperfusion is linked to better 90-day clinical outcomes.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Background:
- Large vessel occlusions (LVOs) are a leading cause of severe stroke.
- Thrombolytic therapy aims to restore blood flow but efficacy can vary.
- Assessing reperfusion rates and their impact on outcomes is crucial for treatment optimization.
Purpose of the Study:
- To compare the reperfusion rates of tenecteplase versus alteplase in patients with LVOs.
- To investigate if the time from thrombolytic administration to reperfusion assessment influences treatment efficacy.
- To evaluate the association between reperfusion and 90-day clinical outcomes.
Main Methods:
- A comparative analysis of patients from the Melbourne Stroke Registry and EXTEND-IA trials.
- Thrombolytic-induced reperfusion defined as absence of retrievable thrombus or >50% reperfusion.
- Poisson modeling used to compare tenecteplase and alteplase reperfusion rates, accounting for time to assessment.
- Ordinal logistic regression used to compare 90-day outcomes between thrombolysis and endovascular therapy reperfusion.
Main Results:
- Tenecteplase showed significantly higher reperfusion rates (aIRR = 1.50) compared to alteplase.
- Higher reperfusion rates with tenecteplase were observed in middle cerebral artery occlusion subgroups.
- Increased time to reperfusion assessment was associated with reperfusion for both agents.
- Reperfusion achieved with thrombolysis correlated with improved 90-day modified Rankin Scale scores.
Conclusions:
- Tenecteplase is more effective than alteplase in achieving prethrombectomy reperfusion in LVO stroke.
- The benefit of tenecteplase is independent of the time to reperfusion assessment.
- Achieving reperfusion with thrombolysis is associated with better functional outcomes at 90 days.
