Early Recanalization Among Patients Undergoing Bridging Therapy With Tenecteplase or Alteplase
Early Recanalization Among Patients Undergoing Bridging Therapy With Tenecteplase or Alteplase
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DOI：
10.1161/strokeaha.123.042691
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发表时间：
2023-10-01
期刊：
影响因子：
8.3
通讯作者：
Alamowitch，Sonia
中科院分区：
文献类型：
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作者：
Checkouri，Thomas;Gerschenfeld，Gaspard;Alamowitch，Sonia
背景：机械取栓前应用阿替普酶或替奈普酶静脉溶栓是大血管闭塞急性缺血性卒中的推荐治疗方法。关于这些药物在机械取栓前早期再通（ER）率方面是否存在差异，目前的数据存在分歧，并且很少有数据表明它们的潜在差异是由诸如IVT- ER评估（IVT-to- eval）时间、闭塞部位和血栓长度等ER预测因素分层的。方法：我们回顾性比较来自PREDICT-RECANAL（阿替普酶）和tenecteplase治疗缺血性卒中（tenecteplase）法国多中心登记的前循环大血管闭塞急性缺血性卒中患者IVT后使用tenecteplase或阿替普酶发生ER的可能性。ER被定义为首次血管造影时脑梗死血栓溶解评分为2b-3，或早期神经系统改善患者的无创血管成像。分析基于倾向评分重叠加权（导致患者病史、卒中特征和组间初始管理的精确平衡），并通过调整后的逻辑回归（敏感性分析）进行证实。基于预先建立的ER预测因子（IVT-to-ERevaltime，闭塞部位和血栓长度）进行分层分析。结果共纳入1865例患者。使用替奈普酶或阿替普酶的患者中，ER发生率分别为156/787例（19.8%）和199/1078例（18.5%）（优势比1.09 [95% CI, 0.83-1.44]；P=0.52）。tenecteplase与alteplase对血栓长度不同的ER发生概率有不同的影响（P相互作用=0.003），tenecteplase与血栓直径10mm的ER发生几率较高相关（比值比为2.43 [95% CI, 1.02-5.81]；P=0.04）。根据IVT-to-ERevaltime （p互作=0.40）或闭塞部位（p互作=0.80），tenecteplase与alteplase对ER发生可能性的影响没有差异。结论大血管闭塞性急性缺血性脑卒中患者中有五分之一的溶栓药物均能达到ER，且与ivt -to- evaltime和闭塞部位无显著相互作用。与阿替普酶相比，tenecteplase与较大血栓中ER的可能性高2倍相关。
BACKGROUNDIntravenous thrombolysis (IVT) with alteplase or tenecteplase before mechanical thrombectomy is the recommended treatment for large-vessel occlusion acute ischemic stroke. There are divergent data on whether these agents differ in terms of early recanalization (ER) rates before mechanical thrombectomy, and little data on their potential differences stratified by ER predictors such as IVT to ER evaluation (IVT-to-EReval) time, occlusion site and thrombus length.METHODSWe retrospectively compared the likelihood of ER after IVT with tenecteplase or alteplase in anterior circulation large-vessel occlusion acute ischemic stroke patients from the PREDICT-RECANAL (alteplase) and Tenecteplase Treatment in Ischemic Stroke (tenecteplase) French multicenter registries. ER was defined as a modified Thrombolysis in Cerebral Infarction score 2b-3 on the first angiographic run, or noninvasive vascular imaging in patients with early neurological improvement. Analyses were based on propensity score overlap weighting (leading to exact balance in patient history, stroke characteristics, and initial management between groups) and confirmed with adjusted logistic regression (sensitivity analysis). A stratified analysis based on pre-established ER predictors (IVT-to-ERevaltime, occlusion site, and thrombus length) was conducted.RESULTSOverall, 1865 patients were included. ER occurred in 156/787 (19.8%) and 199/1078 (18.5%) patients treated with tenecteplase or alteplase, respectively (odds ratio, 1.09 [95% CI, 0.83–1.44];P=0.52). A differential effect of tenecteplase versus alteplase on the probability of ER according to thrombus length was observed (Pinteraction=0.003), with tenecteplase being associated with higher odds of ER in thrombi >10 mm (odds ratio, 2.43 [95% CI, 1.02–5.81];P=0.04). There was no differential effect of tenecteplase versus alteplase on the likelihood of ER according to the IVT-to-ERevaltime (Pinteraction=0.40) or occlusion site (Pinteraction=0.80).CONCLUSIONSBoth thrombolytics achieved ER in one-fifth of patients with large-vessel occlusion acute ischemic stroke without significant interaction with IVT-to-ERevaltime and occlusion site. Compared with alteplase, tenecteplase was associated with a 2-fold higher likelihood of ER in larger thrombi.