Functional Outcome, Recanalization, and Hemorrhage Rates After Large Vessel Occlusion Stroke Treated With Tenecteplase Before Thrombectomy.
Neurology. 2021-11-30; 97(22):
DOI: 10.1212/wnl.0000000000012915
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Gerschenfeld G(1), Smadja D(1), Turc G(1), Olindo S(1), Laborne FX(1), Yger
M(1), Caroff J(1), Gonçalves B(1), Seners P(1), Cantier M(1), l’Hermitte Y(1),
Aghasaryan M(1), Alecu C(1), Marnat G(1), Ben Hassen W(1), Kalsoum E(1),
Clarençon F(1), Piotin M(1), Spelle L(1), Denier C(1), Sibon I(1), Alamowitch
S(1), Chausson N(2); TETRIS Study Group.
Collaborators: Degos V, Sarov M, Legris N, Chassin O, Soumah D, Altarcha T,
Imbernon C, Renou P, Poli M, Debruxelles S, Sagnier S, Rouanet F, Liegey JS,
Calvet D, Baron JC, Bottin L, Delorme S, Capron J, Doukhi D, Ghazanfari S,
Weisenburger D, Lescieux E, Gariel F, Barreau X, Menegon P, Tourdias T,
Oppenheim C, Naggara O, Tuilier T, Sourour N, Sourour N, Shotar E, Lenck S,
Premat K, Blanc R, Escalard S, Fahed R, Smajda S, Mazighi M.
Author information:
(1)From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.),
Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine
(G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité
Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique
(F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie
(G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et
Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de
Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie
Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de
Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie
(C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie
(E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.),
Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle
(M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne
Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France.
(2)From the Service des Urgences cérébro-vasculaires (G.G., M.Y., M.C., S.A.),
Hôpital Pitié-Salpêtrière, Hôpital Saint-Antoine, APHP; Faculté de Médecine
(G.G.), Sorbonne Université, Paris; Service de Neurologie, Unité
Neuro-vasculaire (D.S., Y.H., M.A., C.A., N.C.), and Unité de Recherche Clinique
(F.-X.L.), Hôpital Sud Francilien, Corbeil-Essonnes; Services de Neurologie
(G.T., B.G., P.S.) and Neuroradiologie (W.B.H.), GHU Paris Psychiatrie et
Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc; Service de
Neurologie, Unité Neuro-vasculaire (S.O., I.S.), and Service de Neuroradiologie
Diagnostique et Interventionnelle (G.M.), CHU de Bordeaux; Service de
Neuroradiologie Interventionnelle (NEURI) (J.C., L.S.) and Service de Neurologie
(C.D.), Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre; Service de Neuroradiologie
(E.K.), Hôpital Henri-Mondor, AP-HP, Créteil; Service de Neuroradiologie (F.C.),
Hôpital Pitié-Salpêtrière, AP-HP; Service de Neuroradiologie Interventionnelle
(M.P.), Hôpital Fondation Rothschild, Paris; and CRSA (S.A.), Sorbonne
Université, INSERM, UMRS 938, Hôpital Saint-Antoine, Paris, France.
.
BACKGROUND AND OBJECTIVES: To investigate in routine care the efficacy and
safety of IV thrombolysis (IVT) with tenecteplase prior to mechanical
thrombectomy (MT) in patients with large vessel occlusion acute ischemic strokes
(LVO-AIS), either secondarily transferred after IVT or directly admitted to a
comprehensive stroke center (CSC).
METHODS: We retrospectively analyzed clinical and procedural data of patients
treated with 0.25 mg/kg tenecteplase within 270 minutes of LVO-AIS who underwent
brain angiography. The main outcome was 3-month functional independence
(modified Rankin Scale score ≤2). Recanalization (revised Treatment in Cerebral
Ischemia score 2b-3) was evaluated before (pre-MT) and after MT (final).
RESULTS: We included 588 patients (median age 75 years [interquartile range
(IQR) 61-84]; 315 women [54%]; median NIH Stroke Scale score 16 [IQR 10-20]), of
whom 520 (88%) were secondarily transferred after IVT. Functional independence
occurred in 47% (n = 269/570; 95% confidence interval [CI] 43.0-51.4) of
patients. Pre-MT recanalization occurred in 120 patients (20.4%; 95% CI
17.2-23.9), at a similar rate across treatment paradigms (direct admission, n =
14/68 [20.6%]; secondary transfer, n = 106/520 [20.4%]; p > 0.99) despite a
shorter median IVT to puncture time in directly admitted patients (38 [IQR
23-55] vs 86 [IQR 70-110] minutes; p < 0.001). Final recanalization was achieved
in 492 patients (83.7%; 95%CI 80.4-86.6). Symptomatic intracerebral hemorrhage
occurred in 2.5% of patients (n = 14/567; 95% CI 1.4-4.1).
DISCUSSIONS: Tenecteplase before MT is safe, effective, and achieves a fast
recanalization in everyday practice in patients secondarily transferred or
directly admitted to a CSC, in line with published results. These findings
should encourage its wider use in bridging therapy.
CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that
tenecteplase within 270 minutes of LVO-AIS increases the probability of
functional independence.
© 2021 American Academy of Neurology.
DOI: 10.1212/WNL.0000000000012915
PMID: 34635558 [Indexed for MEDLINE]