Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA.
J Neuroimaging. 2012 Jul;22(3):249-54. doi: 10.1111/j.1552-6569.2011.00628.x. Epub 2011 Aug 29.
Tenecteplase (TNK) is a third-generation thrombolytic agent. We evaluated the safety and feasibility of intra-arterial (IA) administration of TNK in patients with acute ischemic stroke.
Patients who received endovascular treatment for acute ischemic stroke were identified from prospectively collected databases at three university hospitals. We compared clinical and radiological outcomes of patients treated with TNK to those treated with other IA thrombolytics or mechanical thrombectomy alone. Primary outcome measures were favorable functional outcome at 30 days (modified Rankin Scale score of 0-2), and rate of intracranial hemorrhage (ICH). Early neurological improvement, angiographic recanalization, time to recanalization, and mortality at 30 days were additional outcome measures.
We identified 114 patients (mean age 67 ± 15 years, 54 were women). Thirty-three patients received IA TNK, 48 received alteplase (n = 11) or reteplase (n = 37), and 33 patients had mechanical thrombectomy alone. Stroke severity was similar among the three groups. No difference between the groups was found in the secondary outcome measures and ICH. Borderline statistical significance was seen toward favorable functional outcome at 1 month in the TNK-treated patients [odds ratio (OR) = 2.8; 95% confidence interval (CI) .96-8.1, P = .063 vs. other thrombolytics, and OR = 3.0, 95% CI .97-9.5, P = .06 vs. mechanical thrombectomy alone].
Our study demonstrates that administration of IA TNK in acute stroke is safe and results in rates of favorable outcomes that are comparable to those observed with currently used drugs. Additional studies are needed to further determine the safety and efficacy of IA TNK in acute stroke treatment.
替奈普酶（TNK）是第三代溶栓剂。我们评估了替奈普酶动脉内（IA）给药治疗急性缺血性脑卒中患者的安全性和可行性。
我们从三所大学医院前瞻性收集的数据库中确定了接受血管内治疗的急性缺血性脑卒中患者。我们比较了接受 TNK 治疗的患者与接受其他 IA 溶栓剂或单独机械取栓治疗的患者的临床和影像学结局。主要结局指标为 30 天的良好功能结局（改良 Rankin 量表评分 0-2）和颅内出血（ICH）发生率。早期神经改善、血管再通率、再通时间和 30 天死亡率为其他结局指标。
我们确定了 114 例患者（平均年龄 67±15 岁，54 例为女性）。33 例患者接受 IA TNK 治疗，48 例患者接受阿替普酶（n=11）或瑞替普酶（n=37）治疗，33 例患者单独接受机械取栓治疗。三组患者的卒中严重程度相似。三组患者在次要结局指标和 ICH 方面无差异。TNK 治疗组 1 个月时的良好功能结局有边缘统计学意义[优势比（OR）=2.8；95%置信区间（CI）.96-8.1，P=0.063 比其他溶栓剂，OR=3.0，95%CI.97-9.5，P=0.06 比单独机械取栓]。
我们的研究表明，急性脑卒中患者 IA 给予 TNK 是安全的，其结果与目前使用的药物观察到的良好结局发生率相当。需要进一步的研究来进一步确定 IA TNK 在急性脑卒中治疗中的安全性和疗效。
