1. Functional Outcome, Recanalization, and Hemorrhage Rates After Large Vessel Occlusion Stroke Treated With Tenecteplase Before Thrombectomy
- Author
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Gaspard, Gerschenfeld, Didier, Smadja, Guillaume, Turc, Stephane, Olindo, François-Xavier, Laborne, Marion, Yger, Jildaz, Caroff, Bruno, Gonçalves, Pierre, Seners, Marie, Cantier, Yann, l'Hermitte, Manvel, Aghasaryan, Cosmin, Alecu, Gaultier, Marnat, Wagih, Ben Hassen, Erwah, Kalsoum, Frédéric, Clarençon, Michel, Piotin, Laurent, Spelle, Christian, Denier, Igor, Sibon, Sonia, Alamowitch, Nicolas, Chausson, Mikael, Mazighi, Service de Neurologie [CHU Saint-Antoine], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), Service de Neurologie et Unité Neurovasculaire [Centre Hospitalier Sud-Francilien], Université Paris-Sud - Paris 11 (UP11)-Centre Hospitalier Sud Francilien, CH Evry-Corbeil-CH Evry-Corbeil, Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), GHU Paris Psychiatrie et Neurosciences, FHU NeuroVasc [Site Sainte-Anne, Paris] (GHU-PPN), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Service de neurologie [Bordeaux], CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Centre Hospitalier Sud Francilien, CH Evry-Corbeil, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service de Neurologie, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc, Paris, France, CHU Bordeaux [Bordeaux], CHU Henri Mondor, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], TETRIS study group, Martinez Rico, Clara, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
- Subjects
Male ,Tenecteplase ,030204 cardiovascular system & hematology ,Brain Ischemia ,Ischemia score ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Modified Rankin Scale ,Interquartile range ,medicine ,Humans ,Thrombolytic Therapy ,In patient ,[SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,Stroke ,Aged ,Cerebral Hemorrhage ,Ischemic Stroke ,Retrospective Studies ,Thrombectomy ,Aged, 80 and over ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,3. Good health ,Treatment Outcome ,Anesthesia ,Angiography ,Female ,[SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology ,Large vessel occlusion ,medicine.drug - Abstract
Background and ObjectivesTo 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).MethodsWe 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).ResultsWe 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).DiscussionsTenecteplase 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 EvidenceThis study provides Class IV evidence that tenecteplase within 270 minutes of LVO-AIS increases the probability of functional independence.
- Published
- 2021