From the Department of Medicine and Neurology (F. Alemseged, G.S., L.C., B.Y., M.W.P., S.M.D., P.J.M., N.Y. B.C.V.C.), University of Melbourne, and Department of Radiology (C.W., S.B., R.D.), Royal Melbourne Hospital, Parkville, Australia; Stroke Unit (F. Alemseged, A.R., F.S., M.D.) and Department of Biomedicine and Prevention (F.D.), University Hospital of Tor Vergata, Rome, Italy; Department of Neurology (F.C.N.), Austin Health, Melbourne, Australia; Department of Neurology (V.P.), Institute of Neuroradiology (D.K.), and Dresden Neurovascular Center (V.P., D.K.), University of Technology Dresden, Germany; Department of Interventional Neuroradiology (G.B.), Sainte-Anne-Hospital, Paris, France; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Department of Neurology (T.Y.W.), Christchurch Hospital, New Zealand; Division of Medicine (D.S.), Princess Alexandra Hospital, Brisbane, Australia; NEUROFARBA Department (F. Arba), Careggi University Hospital, Florence; ASST Valcamonica (A.M.), Department of Neurology, Esine, Italy; Department of Neurosciences (H.M.D.), Eastern Health, Melbourne; Department of Neurology (P.B.), Gold Coast University Hospital, Queensland; Department of Neurology (B.O.), Gosford Hospital, New South Wales; and Population Health and Immunity Division (N.Y.), The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
Neurology. 2021 Mar 2;96(9):e1272-e1277. doi: 10.1212/WNL.0000000000011520. Epub 2021 Jan 6.
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).
To determine whether TNK is associated with better reperfusion rates than alteplase prior to EVT in BAO, clinical and procedural data of consecutive patients with BAO from the Basilar Artery Treatment and Management (BATMAN) registry and the Tenecteplase vs 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.
We included 110 patients with BAO treated with IV thrombolysis prior to EVT (mean age 69 [SD 14] years; median NIH Stroke Scale score 16 [interquartile range (IQR) 7-32]). Nineteen patients were thrombolysed with TNK (0.25 mg/kg or 0.40 mg/kg) and 91 with alteplase (0.9 mg/kg). Reperfusion >50% occurred in 26% (n = 5/19) of patients thrombolysed with TNK vs 7% (n = 6/91) thrombolysed with alteplase (risk ratio 4.0, 95% confidence interval 1.3-12; = 0.02), despite shorter thrombolysis to arterial puncture time in the TNK-treated patients (48 [IQR 40-71] minutes) vs alteplase-treated patients (110 [IQR 51-185] minutes; = 0.004). No difference in symptomatic intracranial hemorrhage was observed (0/19 [0%] TNK, 1/91 [1%] alteplase; = 0.9).
TNK may be associated with an increased rate of reperfusion in comparison with alteplase before EVT in BAO. Randomized controlled trials to compare TNK with alteplase in patients with BAO are warranted.
NCT02388061 and NCT03340493.
This study provides Class III evidence that TNK leads to higher reperfusion rates in comparison with alteplase prior to EVT in patients with BAO.
研究替奈普酶（TNK）在血管内血栓切除术（EVT）前对基底动脉闭塞（BAO）患者的疗效，TNK 是一种纤维蛋白特异性更强、半衰期比阿替普酶更长的基因改良变体。
为了确定 TNK 是否比 EVT 前的阿替普酶具有更好的再灌注率，我们回顾性分析了来自基底动脉治疗和管理（BATMAN）登记处和替奈普酶与阿替普酶在缺血性卒中血管内治疗前（EXTEND-IA TNK）试验的连续 BAO 患者的临床和程序数据。评估初始血管造影时>50%的再灌注或不存在可回收血栓。
我们纳入了 110 例接受 EVT 前 IV 溶栓治疗的 BAO 患者（平均年龄 69 [14]岁；中位数 NIH 卒中量表评分 16 [四分位距 7-32]）。19 例患者接受 TNK（0.25mg/kg 或 0.40mg/kg）溶栓，91 例患者接受阿替普酶溶栓。TNK 溶栓患者的再灌注率>50%为 26%（n=5/19），阿替普酶溶栓患者为 7%（n=6/91）（风险比 4.0，95%置信区间 1.3-12；P=0.02），尽管 TNK 治疗患者的溶栓至动脉穿刺时间更短（48 [四分位距 40-71]分钟）vs 阿替普酶治疗患者（110 [四分位距 51-185]分钟；P=0.004）。未观察到症状性颅内出血的差异（0/19 [0%] TNK，1/91 [1%] 阿替普酶；P=0.9）。
与 EVT 前的阿替普酶相比，TNK 可能与 BAO 患者再灌注率增加相关。需要进行随机对照试验比较 TNK 与阿替普酶在 BAO 患者中的疗效。
NCT02388061 和 NCT03340493。
本研究提供了 III 级证据，表明与 EVT 前的阿替普酶相比，TNK 可使 BAO 患者的再灌注率更高。
