Recanalization before Thrombectomy in Tenecteplase vs. Alteplase-Treated Drip-and-Ship Patients

Seners, Pierre; Caroff, Jildaz; Chausson, Nicolas; Turc, Guillaume; Denier, Christian; Piotin, Michel; Aghasaryan, Manvel; Alecu, Cosmin; Chassin, Olivier; Lapergue, Bertrand; Naggara, Olivier; Ferrigno, Marc; Arquizan, Caroline; Cho, Tae-Hee; Narata, Ana-Paula; Richard, Sébastien; Bricout, Nicolas; Mazighi, Mikaël; Costalat, Vincent; Gory, Benjamin; Debiais, Séverine; Consoli, Arturo; Bracard, Serge; Oppenheim, Catherine; Mas, Jean‐Louis; Smadja, Didier; Spelle, Laurent; Baron, Jean‐Claude

doi:10.5853/jos.2018.01998

Cited by 45 publications

(60 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These associations were consistent across both adjusted and unadjusted analyses. 31,32 In addition, our findings contradict a recent report from Australia showing higher rates of clot migration to distal (M2, M3, and beyond) middle cerebral artery branches prior to the onset of MT with IVT pretreatment. We also documented no increase in the risk of post-MT complications (any ICH, groin hematoma, distal embolization, infarct in new vessel territory) for BT compared to dMT.…”

Section: Discussioncontrasting

confidence: 92%

“…[27][28][29] According to RCT data, IVT pretreatment averts the need for MT due to successful vessel recanalization or clinical improvement in 11% of LVO patients, 30 a potentially underestimated proportion, as unselected population data suggest an up to 30% successful recanalization rate after IVT. 31,32 In addition, our findings contradict a recent report from Australia showing higher rates of clot migration to distal (M2, M3, and beyond) middle cerebral artery branches prior to the onset of MT with IVT pretreatment. 33 In view of the former considerations, we consider that our findings lend support to current international recommendations advocating that all tPA-eligible LVO 34,35 Compared to the previously published meta-analyses, our report includes a significantly higher number of studies, patients, and outcomes ( Supplementary Table 27).…”

Section: Discussioncontrasting

confidence: 92%

See 1 more Smart Citation

Intravenous thrombolysis prior to mechanical thrombectomy in large vessel occlusions

Katsanos

Malhotra

Goyal

et al. 2019

Annals of Neurology

Self Cite

View full text Add to dashboard Cite

Objective: The substantial clinical improvement in acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT), combined with the poor response of proximal intracranial occlusions to intravenous thrombolysis (IVT), led to questions regarding the utility of bridging therapy (BT; IVT followed by MT) compared to direct mechanical thrombectomy (dMT) for AIS patients with large vessel occlusion (LVO). Methods: We aimed to investigate the comparative safety and efficacy of BT and dMT in AIS patients. We included all observational studies and post hoc analyses from randomized controlled clinical trials that provided data on the outcomes of AIS patients with LVO stratified by IVT treatment status prior to MT. Results: We identified 38 eligible observational studies (11,798 LVO patients, mean age = 68 years, 56% treated with BT). In unadjusted analyses, BT was associated with a higher likelihood of 3-month functional independence (odds ratio [OR] = 1.52, 95% confidence interval [CI] = 1.32-1.76), 3-month functional improvement (common OR [cOR] for 1-point decrease in modified Rankin Scale score = 1.52, 95% CI = 1.18-1.97), early neurological improvement (OR = 1.21, 95% CI = 1.83-1.76), successful recanalization (OR = 1.22, 95% CI = 1.02-1.46), and successful recanalization with ≤2 device passes (OR = 2.28, 95% CI = 1.43-3.64) compared to dMT. BT was also related to a lower likelihood of 3-month mortality (OR = 0.64, 95% CI = 0.57-0.73). In the adjusted analyses, BT was independently associated with a higher likelihood of 3-month functional independence (adjusted OR = 1.55, 95% CI = 1.26-1.91) and lower odds of 3-month mortality (adjusted OR = 0.80, 95% CI = 0.66-0.97) compared to dMT. The two groups did not differ in functional improvement (adjusted cOR = 1.24, 95% CI = 0.89-1.74) or symptomatic intracranial hemorrhage (adjusted OR = 0.87, 95% CI = 0.61-1.25).Interpretation: BT appears to be associated with improved functional independence without evidence for safety concerns, compared to dMT, for AIS patients with LVO.

show abstract

Section: Discussioncontrasting

confidence: 92%

Section: Discussioncontrasting

confidence: 92%

Intravenous thrombolysis prior to mechanical thrombectomy in large vessel occlusions

Katsanos

Malhotra

Goyal

et al. 2019

Annals of Neurology

Self Cite

View full text Add to dashboard Cite

show abstract

“… 5 Real-world observational studies like ours can provide further data and lend support to the generalizability of the major RCT results into everyday clinical practice. 23 …”

Section: Discussionmentioning

confidence: 99%

Real-world comparative safety and efficacy of tenecteplase versus alteplase in acute ischemic stroke patients with large vessel occlusion

Psychogios

Palaiodimou

Katsanos

et al. 2021

Ther Adv Neurol Disord

View full text Add to dashboard Cite

Background and aims: Tenecteplase has recently emerged as an alternative thrombolytic agent in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO), possibly superior in achieving early reperfusion compared with alteplase. We aimed to compare the safety and efficacy of intravenous tenecteplase with intravenous alteplase for AIS patients with LVO in everyday clinical practice settings. Methods: We prospectively evaluated patients with AIS due to LVO, treated with intravenous thrombolysis (IVT) with or without mechanical thrombectomy in two tertiary stroke centers. Patients were treated with standard-dose alteplase (0.9 mg/kg) or 0.25 mg/kg tenecteplase. Safety outcomes included prevalence of symptomatic intracranial hemorrhage (sICH) and mortality. Efficacy outcomes included averted thrombectomy, major neurological improvement at 24 h (defined as decrease in baseline NIHSS score of 8 points or greater) and functional status on discharge and on 3 months assessed by modified Rankin Scale (mRS). Results: Nineteen AIS patients with LVO received tenecteplase and 39 received alteplase. We observed a non-significant higher rate of averted thrombectomies (32% versus 18%, p = 0.243) and a non-significant higher rate of sICH (16% versus 5%, p = 0.201) in the tenecteplase group. The rate of 24 h major neurological improvement was higher in the tenecteplase group (64% versus 33%, p = 0.046) but this was marginally attenuated in multivariable analyses (adjusted OR 10.22, 95% CI: 0.73–142.98; p = 0.084). Discharge mRS, 3-months mRS, and 3-month functional independence (mRS scores of 0–2) did not differ ( p > 0.2) between the two groups. The rates of 3-month mortality (11% versus 18%, p = 0.703) were similar in the two groups. No independent association between thrombolytic agent and safety or efficacy outcomes emerged in multivariable regression analyses. Conclusion: The present pilot observational study highlights that AIS patients with LVO treated with 0.25 mg/kg bolus administration of tenecteplase had increased likelihood to achieve early neurological improvement compared with AIS patients treated with alteplase, but this association was attenuated after adjustment for potential confounders. There were no significant differences in 3-month functional or safety outcomes between the two groups. This preliminary real-world observation requires independent confirmation in larger, multicenter studies.

show abstract

“…With EVT becoming the standard treatment, bridging therapy with IV t-PA before EVT in patients with LVO is a debated issue [ 8 ]. This is because, in patients with LVO, recanalization is achieved immediately after t-PA in only about 10% to 15% [ 4 , 5 , 13 , 14 , 19 , 21 ] and t-PA may increase the risk of bleeding and distal embolization of partially lysed clots. It may also delay the begin.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion

et al. 2021

View full text Add to dashboard Cite

Background and Purpose We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion.Methods Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization.Results Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; P=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; P=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; P=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; P=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; P=0.032).Conclusions The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.

show abstract

Recanalization before Thrombectomy in Tenecteplase vs. Alteplase-Treated Drip-and-Ship Patients

Cited by 45 publications

References 6 publications

Intravenous thrombolysis prior to mechanical thrombectomy in large vessel occlusions

Intravenous thrombolysis prior to mechanical thrombectomy in large vessel occlusions

Real-world comparative safety and efficacy of tenecteplase versus alteplase in acute ischemic stroke patients with large vessel occlusion

Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion

Contact Info

Product

Resources

About