Early Reperfusion in Basilar Artery Occlusion Stroke Managed With Tenecteplase Versus Alteplase Before Endovascular Treatment.
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Wolman Dylan N, Karamchandani Rahul R, Darko Kwadwo, Bielinski Tyler M, Goyal Nitin, Rhoten Jeremy B, Jayaraman Mahesh V, Sidebottom Christian T, Gross Bradley A, Al-Bayati Alhamza R, Doheim Mohamed F, Tobin Matthew K, Chinthala Anoop, Gajjar Avi, Mascitelli Justin, Webb Matthew R, Burkhardt Jan-Karl, Scott Kyle W, Srinivasan Visish, Tonetti Daniel, Koneru Manisha, Altschul David J, Vaishnav Dhrumhil, Multani Sumeet, Theofanis Thana, Ares William J, Sone Je Yeong, Zand Ramin, Bahrami Sasan, Li Jiang, Defilipp Gary, Strong Dale, Torabi Radmehr, Moldovan Krisztina, Schirmer Clemens M, Nogueira Raul G, Bohnstedt Bradley N, Paul Alexandra R, Hendrix Philipp
Аннотация
METHODS: This was a retrospective, multicenter US cohort of consecutive patients with BAO from 14 stroke centers treated with tenecteplase or alteplase within 4.5 hours of last known well before endovascular treatment. The primary end point was ER, defined as angiographic ER (expanded Thrombolysis in Cerebral Infarction grade 2b to 3 on the first diagnostic angiogram), or clinical ER, defined as substantial neurological improvement precluding endovascular treatment and a good functional outcome (modified Rankin Scale score 0-3).
RESULTS: Among 163 patients with BAO and a median last known well-to-needle time of 135 minutes (interquartile range, 100-193) and last known well-to-puncture time of 228 minutes (interquartile range, 166-307), ER was observed in 27 (16.6%) patients. Rates of ER were comparable between tenecteplase (14/75, 18.7%) and alteplase (13/88, 14.8%; adjusted odds ratio, 1.082 [95% CI, 0.444-2.631]; P=0.862). In addition, rates of angiographic ER and clinical ER subgroups did not differ between thrombolytic agents. Higher Basilar Artery on Computed Tomography Angiography scores and a nonatherothrombotic cause independently predicted ER. In multivariable analysis, a good functional outcome was associated with younger age, lower stroke burden, and shorter last known well-to-puncture time.
CONCLUSIONS: In BAO treated within 4.5 hours of last known well, tenecteplase and alteplase produced comparable early reperfusion rates. Achieving ER did not modify the association between thrombolytic agent and good functional outcome, consistent with rapid thrombectomy in patients with no ER.