Tenecteplase versus alteplase before endovascular therapy in basilar artery occlusion
Date
2021
Authors
Alemseged, F.
Ng, F.C.
Williams, C.
Puetz, V.
Boulouis, G.
Kleinig, T.J.
Rocco, A.
Wu, T.Y.
Shah, D.
Arba, F.
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Journal article
Citation
Neurology, 2021; 96(9):e1272-e1277
Statement of Responsibility
Fana Alemseged, Felix C. Ng, Cameron Williams, Volker Puetz, Gregoire Boulouis, Timothy John Kleinig, Alessandro Rocco, Teddy Y. Wu, Darshan Shah, Francesco Arba, Daniel Kaiser, Francesca Di Giuliano, Andrea Morotti, Fabrizio Sallustio, Helen M. Dewey, Peter Bailey, Billy O’Brien, Gagan Sharma, Steven Bush, Richard Dowling, Marina Diomedi, Leonid Churilov, Bernard Yan, Mark William Parsons, Stephen M. Davis, Peter J. Mitchell, Nawaf Yassi, and Bruce C.V. Campbell, on behalf of the BATMAN study group and EXTEND IA TNK study group
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Abstract
Objective: To investigate the efficacy of tenecteplase (TNK), a genetically modified variant of alteplase with greater fibrin specificity and longer half-life than alteplase, prior to endovascular thrombectomy (EVT) in patients with basilar artery occlusion (BAO). Methods: To determine whether TNK is associated with better reperfusion rates than alteplase prior to EVT in BAO, clinical and procedural data of consecutive patients with BAO from the Basilar Artery Treatment and Management (BATMAN) registry and the Tenecteplase vs Alteplase before Endovascular Therapy for Ischemic Stroke (EXTEND-IA TNK) trial were retrospectively analyzed. Reperfusion >50% or absence of retrievable thrombus at the time of the initial angiogram was evaluated. Results: We included 110 patients with BAO treated with IV thrombolysis prior to EVT (mean age 69 [SD 14] years; median NIH Stroke Scale score 16 [interquartile range (IQR) 7–32]). Nineteen patients were thrombolysed with TNK (0.25 mg/kg or 0.40 mg/kg) and 91 with alteplase (0.9 mg/kg). Reperfusion >50% occurred in 26% (n = 5/19) of patients thrombolysed with TNK vs 7% (n = 6/91) thrombolysed with alteplase (risk ratio 4.0, 95% confidence interval 1.3–12; p = 0.02), despite shorter thrombolysis to arterial puncture time in the TNK-treated patients (48 [IQR 40–71] minutes) vs alteplase-treated patients (110 [IQR 51–185] minutes; p = 0.004). No difference in symptomatic intracranial hemorrhage was observed (0/19 [0%] TNK, 1/91 [1%] alteplase; p = 0.9). Conclusions: TNK may be associated with an increased rate of reperfusion in comparison with alteplase before EVT in BAO. Randomized controlled trials to compare TNK with alteplase in patients with BAO are warranted.
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© 2021 American Academy of Neurology