Tenecteplase Versus Alteplase for First-Pass Reperfusion in Basilar Artery Occlusion Stroke Thrombectomy.
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Wolman Dylan N, Karamchandani Rahul R, Hemmer Sina, 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, Paul Alexandra R, Bohnstedt Bradley N, Nogueira Raul G, Hendrix Philipp
Аннотация
METHODS: We analyzed 163 consecutive BAO patients treated with intravenous TNK or TPA within 4.5 h of last known well across 14 U.S. stroke systems (January 2020-August 2024). Patients with early reperfusion (n = 27) or aborted procedures (n = 3) were excluded. Multivariable ordinal and logistic regression identified predictors of FPE (expanded Thrombolysis in Cerebral Infarction [eTICI] 2c-3) and modified FPE (mFPE, eTICI 2b-3), and FPE/mFPE association with 90-day outcomes (modified Rankin Scale [mRS] 0-3).
RESULTS: FPE occurred in 55 of 133 patients (41.4%) and was more frequent with TNK than TPA (51.7% vs 32.9%, p = 0.029). TNK was independently associated with higher odds of FPE (adjusted odds ratio [aOR] 2.37, 95% confidence interval [CI] 1.13-4.98, p = 0.023) and mFPE (aOR 2.74, 95% CI 1.20-6.25, p = 0.017). Both FPE and mFPE were independently associated with ambulatory outcomes at 90-days (FPE: aOR 2.94, 95% CI 1.18-7.33, p = 0.021; mFPE: aOR 5.11, 95% CI 1.81-14.43, p = 0.002). TNK compared with TPA did not show an independent association with functional outcome.
INTERPRETATION: In this multicenter BAO cohort, TNK increased the odds of achieving FPE compared with TPA. As FPE strongly predicted functional recovery, these findings suggest TNK may confer a reperfusion advantage with potential clinical benefit, although a direct outcome effect was not demonstrated. ANN NEUROL 2026;99:692-704.