溶栓类型对抽吸与支架取栓一线血栓切除术疗效的影响：AcT试验结果

Effect of thrombolysis type on the efficacy of aspiration versus stent retriever first line thrombectomy: results from the AcT trial.

作者信息

Bala Fouzi, Diprose William, Menon Bijoy K, Singh Nishita, Khosravani Houman, Tkach Aleksander, Catanese Luciana, Dowlatshahi Dariush, Field Thalia S, Hunter Gary, Sajobi Tolulope, Hill Michael D, Buck Brian H, Swartz Richard H, Almekhlafi Mohammed A

机构信息

Diagnostic and Interventional Neuroradiology Department, Regional University Hospital Centre Tours Radiology Diagnostic and Interventional Neuroradiology, Tours, France

Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.

出版信息

J Neurointerv Surg. 2025 Jun 1;17(e2):e276-e280. doi: 10.1136/jnis-2024-022268.

DOI:10.1136/jnis-2024-022268

PMID:39379314

Abstract

BACKGROUND

Intravenous (IV) tenecteplase is increasingly being used in lieu of alteplase for acute ischemic stroke. We sought to study the influence of IV tenecteplase versus IV alteplase on the efficacy of first line thrombectomy strategy.

METHODS

This was a secondary analysis of the Alteplase versus Tenecteplase (AcT) trial. We included anterior and posterior circulation stroke patients in whom a thrombectomy was attempted. We compared outcomes for stent retriever as first line strategy versus contact aspiration alone, and interactions with thrombolysis type. We examined angiographic outcomes (extended final thrombolysis in cerebral infarction (eTICI) 2c-3 after first-pass, eTICI 2b-3 and eTICI 2 c-3 on final angiography), and clinical and safety outcomes. Mixed effect regression analyses with interaction terms were performed. All outcomes were assessed and analyzed by blinded adjudicators.

RESULTS

Among 506 patients who received thrombectomy, 435 were included (222 (51.0%) IV tenecteplase, 213 (49.0%) IV alteplase). A stent retriever was used as the first line endovascular thrombectomy (EVT) approach in 288 (66.2%), and aspiration in 147 (33.8%) patients. There was no difference in rates of final eTICI 2c-3 between groups (57.0% with stent retriever vs 61.9% with aspiration; P=0.35). There was, however, a significant interaction (P=0.02) between thrombolysis type and first line EVT strategy for final eTICI 2c-3, where tenecteplase was associated with higher odds of final eTICI 2c-3 with aspiration (adjusted OR (aOR) 2.29, 95% CI 1.10 to 4.75), but not with stent retriever (aOR 0.63, 95% CI 0.38 to 1.04). No significant interaction between thrombolysis and first line strategy was found for the other angiographic, clinical or safety outcomes.

CONCLUSION

IV tenecteplase before EVT may enhance reperfusion with first line aspiration.

TRIAL REGISTRATION NUMBER

NCT03889249.

摘要

背景

静脉注射替奈普酶越来越多地被用于替代阿替普酶治疗急性缺血性卒中。我们试图研究静脉注射替奈普酶与静脉注射阿替普酶对一线取栓策略疗效的影响。

方法

这是一项对阿替普酶与替奈普酶（AcT）试验的二次分析。我们纳入了尝试进行取栓的前循环和后循环卒中患者。我们比较了以支架取栓作为一线策略与单纯接触抽吸的结局，以及与溶栓类型的相互作用。我们检查了血管造影结局（首次通过后大脑梗死扩展最终溶栓（eTICI）2c - 3级、最终血管造影时的eTICI 2b - 3级和eTICI 2c - 3级），以及临床和安全性结局。进行了带有交互项的混合效应回归分析。所有结局均由盲法判定者进行评估和分析。

结果

在506例接受取栓的患者中，435例被纳入（222例（51.0%）静脉注射替奈普酶，213例（49.0%）静脉注射阿替普酶）。288例（66.2%）患者将支架取栓用作一线血管内取栓（EVT）方法，147例（33.8%）患者采用抽吸。两组最终eTICI 2c - 3级的发生率无差异（支架取栓组为57.0%，抽吸组为61.9%；P = 0.35）。然而，对于最终eTICI 2c - 3级，溶栓类型与一线EVT策略之间存在显著交互作用（P = 0.02），替奈普酶与抽吸后最终eTICI 2c - 3级的较高比值相关（调整后比值比（aOR）2.29，95%置信区间1.10至4.75），但与支架取栓无关（aOR 0.63，95%置信区间0.38至1.04）。对于其他血管造影、临床或安全性结局，未发现溶栓与一线策略之间存在显著交互作用。