Safety and efficacy of tenecteplase versus alteplase in stroke patients with carotid tandem lesions: Results from the AcT trial-Reference-Cited by-同舟云学术

Safety and efficacy of tenecteplase versus alteplase in stroke patients with carotid tandem lesions: Results from the AcT trial

Published:2023-10-06 Issue: Volume: Page:
ISSN:1747-4930
Container-title:International Journal of Stroke
language:en
Short-container-title:International Journal of Stroke

Author:

Bala Fouzi¹²^ORCID,Almekhlafi Mohammed¹,Singh Nishita¹³^ORCID,Alhabli Ibrahim¹,Ademola Ayoola¹^ORCID,Coutts Shelagh B¹^ORCID,Deschaintre Yan⁴,Khosravani Houman⁵,Appireddy Ramana⁶,Moreau Francois⁷,Phillips Stephen⁸,Gubitz Gord⁸,Tkach Aleksander⁹,Catanese Luciana¹⁰^ORCID,Dowlatshahi Dar¹¹^ORCID,Medvedev George¹²¹³,Mandzia Jennifer¹⁴,Pikula Aleksandra¹⁵,Shankar Jay¹⁶^ORCID,Williams Heather¹⁷,Field Thalia S¹⁸^ORCID,Manosalva Alejandro¹⁹^ORCID,Siddiqui Muzaffar²⁰,Zafar Atif²¹,Imoukhoude Oje²²,Hunter Gary²³,Benali Faysal¹,Horn MacKenzie¹,Hill Michael D¹^ORCID,Shamy Michel¹¹^ORCID,Sajobi Tolulope T¹,Buck Brian H²⁴,Swartz Richard H⁵^ORCID,Menon Bijoy K¹,Poppe Alexandre Y⁴^ORCID

Affiliation:

1. Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada

2. Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France

3. Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

4. Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada

5. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

6. Division of Neurology, Department of Medicine, Queen’s University, Kingston, ON, Canada

7. Université de Sherbrooke, Sherbrooke, QC, Canada

8. Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada

9. Kelowna General Hospital, Kelowna, BC, Canada

10. Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada

11. Department of Medicine, University of Ottawa, Ottawa, ON, Canada

12. The University of British Columbia, Vancouver, BC, Canada

13. Fraser Health Authority, New Westminster, BC, Canada

14. London Health Sciences Centre, Western University, London, ON, Canada

15. Toronto Western Hospital, University of Toronto, Toronto, ON, Canada

16. University of Manitoba, Winnipeg, MB, Canada

17. Queen Elizabeth Hospital, Charlottetown, PEI, Canada

18. Vancouver Stroke Program, Division of Neurology, The University of British Columbia, Vancouver, BC, Canada

19. Medicine Hat Regional Hospital, Medicine Hat, AB, Canada

20. Grey Nuns Community Hospital, Edmonton, AB, Canada

21. St. Michael’s Hospital, Toronto, ON, Canada

22. Red Deer Regional Hospital Centre, Red Deer, AB, Canada

23. University of Saskatchewan, Saskatoon, SK, Canada

24. Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada

Abstract

Background: Carotid tandem lesions ((TL) ⩾70% stenosis or occlusion) account for 15–20% of acute stroke with large vessel occlusion. Aims: We investigated the safety and efficacy of intravenous tenecteplase (0.25 mg/kg) versus intravenous alteplase (0.9 mg/kg) in patients with carotid TL. Methods: This is a substudy of the alteplase compared with the tenecteplase trial. Patients with ⩾70% stenosis of the extracranial internal carotid artery (ICA) and concomitant occlusion of the intracranial ICA, M1 or M2 segments of the middle cerebral artery on baseline computed tomography angiography (CTA) were included. Primary outcome was 90-day-modified Rankin Scale (mRS) 0–1. Secondary outcomes were mRS 0–2, mortality, and symptomatic ICH (sICH). Angiographic outcomes were successful recanalization (revised Arterial Occlusive Lesion (rAOL) 2b–3) on first and successful reperfusion (eTICI 2b–3) on final angiographic acquisitions. Multivariable mixed-effects logistic regression was performed. Results: Among 1577 alteplase versus tenecteplase randomized controlled trial (AcT) patients, 128 (18.8%) had carotid TL. Of these, 93 (72.7%) underwent intravenous thrombolysis plus endovascular thrombectomy (IVT + EVT), while 35 (27.3%) were treated with IVT alone. In the IVT + EVT group, tenecteplase was associated with higher odds of 90-day-mRS 0–1 (46.0% vs. 32.6%, adjusted OR (aOR) 3.21; 95% CI = 1.06–9.71) compared with alteplase. No statistically significant differences in rates of mRS 0–2 (aOR 1.53; 95% CI = 0.51–4.55), initial rAOL 2b–3 (16.3% vs. 28.6%), final eTICI 2b–3 (83.7% vs. 85.7%), and mortality (18.0% vs. 16.3%) were found. SICH only occurred in one patient. There were no differences in outcomes between thrombolytic agents in the IVT-only group. Conclusion: In patients with carotid TL treated with EVT, intravenous tenecteplase may be associated with similar or better clinical outcomes, similar angiographic reperfusion rates, and safety outcomes as compared with alteplase.

Publisher

SAGE Publications

Subject

Neurology,Neurology (clinical)

Link

http://journals.sagepub.com/doi/pdf/10.1177/17474930231205208

Reference31 articles.

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