Department of Neurology, Neurosciences Institute, Atrium Health, 1000 Blythe Blvd, Charlotte, NC, 28203, United States.
Department of Emergency Medicine, Neurosciences Institute, Atrium Health, 1000 Blythe Blvd, Charlotte, NC, 28203, United States.
J Stroke Cerebrovasc Dis. 2024 Nov;33(11):107931. doi: 10.1016/j.jstrokecerebrovasdis.2024.107931. Epub 2024 Aug 13.
Previously published data are conflicting regarding the ability of tenecteplase versus alteplase to produce early recanalization of an intracranial large vessel occlusion. We compared the performance of each thrombolytic in a stroke network.
We queried our prospectively collected code stroke registry for basilar, internal carotid, or proximal middle cerebral artery occlusion patients treated with intravenous thrombolysis from 11/17/2021-9/16/2023. The primary outcome was early recanalization, defined using angiographic or clinical criteria. Secondary and safety outcomes included 90-day functional independence and symptomatic intracranial hemorrhage. A multivariable regression analysis was performed to determine independent associations with the primary outcome.
233 patients, with mean age 66.9 (16.6) years and median National Institutes of Health Stroke Scale score 15 (10-21), were included. One-hundred twenty-four of 233 (53.2 %) patients were treated with alteplase while 109/233 (46.8 %) were treated with tenecteplase. Endovascular thrombectomy was performed in 82 % of subjects. Early recanalization rates were similar between the groups (alteplase 22.6 %, tenecteplase 14.7 %; p = 0.14), as were rates of 90-day independent neurological function, symptomatic intracranial hemorrhage, and mortality. Patients with an internal carotid artery occlusion or with higher presenting stroke severity were less likely to achieve early recanalization.
Tenecteplase and alteplase have similar rates of early recanalization, 90-day functional independence, and safety outcomes in large vessel occlusion patients. Occlusion site and stroke severity predict response to thrombolysis. Future studies may investigate other factors associated with a positive response to thrombolytics as expanded treatment indications are explored.
先前发表的数据在替奈普酶与阿替普酶对颅内大血管闭塞早期再通的能力方面存在矛盾。我们比较了这两种溶栓药物在卒中网络中的表现。
我们从 2021 年 11 月 17 日至 2023 年 9 月 16 日，对我们前瞻性收集的静脉溶栓治疗基底动脉、颈内动脉或大脑中动脉近端闭塞的卒中学科注册中心进行查询。主要结局是采用血管造影或临床标准定义的早期再通。次要结局和安全性结局包括 90 天的功能独立性和症状性颅内出血。采用多变量回归分析确定与主要结局相关的独立因素。
233 例患者，平均年龄 66.9（16.6）岁，中位数国立卫生研究院卒中量表评分 15（10-21），其中 124 例（53.2%）患者接受阿替普酶治疗，109 例（46.8%）患者接受替奈普酶治疗。82%的患者接受了血管内血栓切除术。两组早期再通率相似（阿替普酶组 22.6%，替奈普酶组 14.7%；p=0.14），90 天独立神经功能、症状性颅内出血和死亡率也相似。颈内动脉闭塞或起病时卒中严重程度较高的患者早期再通的可能性较低。
替奈普酶和阿替普酶在大血管闭塞患者中早期再通率、90 天功能独立性和安全性结局相似。闭塞部位和卒中严重程度预测溶栓反应。未来的研究可能会研究其他与溶栓反应阳性相关的因素，因为正在探索扩大治疗适应证。
