Annals of neurology · 2026
Outcomes of Intra-Arterial Tenecteplase after Endovascular Reperfusion for Acute Ischemic Stroke Due to Cardioembolism and Non-Cardioembolism: A Secondary Analysis of the POST-TNK Trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Chai Miao, Zhang Qin, Zhao Xuexiao, Ding Chawen, Zhu Haoxuan, Zhou Sheng, Li Linyu, Liu Zhenqian, Gao Fei, Xu Xu, Ma Jinfu, Wang Zhixi, Li Jiayu, Yang Qiuyi, Chen Yian, Wang Binghan, Chen Mingyang, Yang Yihui, Fan Yuhan, Yuan Junjie, Song Jiaxing, Li Gaoming
Аннотация
OBJECTIVE: This study aimed to evaluate the safety and effectiveness of adjunctive intra-arterial tenecteplase (TNK) in patients with acute ischemic stroke (AIS) due to cardioembolism (CE) and non-CE who achieved near-complete to complete reperfusion (defined as an expanded thrombolysis in cerebral infarction score of 2c-3) following endovascular treatment (EVT).
METHODS: This prespecified secondary analysis of the POST-TNK randomized, open-label, blinded outcome assessment trial categorized 540 patients by stroke etiology into CE (n = 272) and non-CE (n = 268) subgroups. The primary outcome was freedom from disability at 90 days, defined as a modified Rankin Scale score of 0 to 1. Safety outcomes included 90-day mortality, symptomatic intracranial hemorrhage (sICH) within 48 hours, and any intracranial hemorrhage (ICH) within 48 hours.
RESULTS: Among 272 patients with CE (median age, 73 years [interquartile range, 66-78]; 47.1% male), 137 were assigned to the control group and 135 to the intra-arterial TNK group. Compared with the control group, intra-arterial TNK was associated with significantly higher odds of freedom from disability at 90 days (adjusted odds ratio, 1.80; 95% confidence interval [CI], 1.02-3.16; p = 0.04; inverse probability of treatment weighting adjusted odds ratio, 1.58; 95% CI, 1.12-2.22; p = 0.01). No significant differences were observed in 90-day mortality, sICH, or any ICH within 48 hours between groups. Conversely, intra-arterial TNK was not associated with improved functional outcomes in patients with AIS due to non-CE.
INTERPRETATION: In patients with AIS due to CE who achieved near-complete to complete reperfusion after EVT, adjunctive intra-arterial TNK was associated with a higher likelihood of freedom from disability at 90 days, without increasing the risk of mortality or ICH. However, this benefit was not observed in AIS patients due to non-CE. ANN NEUROL 2026;100:841-849.
METHODS: This prespecified secondary analysis of the POST-TNK randomized, open-label, blinded outcome assessment trial categorized 540 patients by stroke etiology into CE (n = 272) and non-CE (n = 268) subgroups. The primary outcome was freedom from disability at 90 days, defined as a modified Rankin Scale score of 0 to 1. Safety outcomes included 90-day mortality, symptomatic intracranial hemorrhage (sICH) within 48 hours, and any intracranial hemorrhage (ICH) within 48 hours.
RESULTS: Among 272 patients with CE (median age, 73 years [interquartile range, 66-78]; 47.1% male), 137 were assigned to the control group and 135 to the intra-arterial TNK group. Compared with the control group, intra-arterial TNK was associated with significantly higher odds of freedom from disability at 90 days (adjusted odds ratio, 1.80; 95% confidence interval [CI], 1.02-3.16; p = 0.04; inverse probability of treatment weighting adjusted odds ratio, 1.58; 95% CI, 1.12-2.22; p = 0.01). No significant differences were observed in 90-day mortality, sICH, or any ICH within 48 hours between groups. Conversely, intra-arterial TNK was not associated with improved functional outcomes in patients with AIS due to non-CE.
INTERPRETATION: In patients with AIS due to CE who achieved near-complete to complete reperfusion after EVT, adjunctive intra-arterial TNK was associated with a higher likelihood of freedom from disability at 90 days, without increasing the risk of mortality or ICH. However, this benefit was not observed in AIS patients due to non-CE. ANN NEUROL 2026;100:841-849.