Functional Outcome, Recanalization, and Hemorrhage Rates After Large Vessel Occlusion Stroke Treated With Tenecteplase Before Thrombectomy
Gaspard Gerschenfeld, Didier Smadja, Guillaume Turc, Stéphane Olindo, François-Xavier Laborne, Marion Yger, Jildaz Caroff, Bruno Gonçalves, Pierre Seners, Marie Cantier, Y. 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, on behalf of the TETRIS Study Group, Vincent Degos, Mariana Sarov, Nicolas Legris, Olivier Chassin, Djibril Soumah, Tony Altarcha, Carole Imbernon, Pauline Renou, Mathilde Poli, Sabrina Debruxelles, Sharmila Sagnier, François Rouanet, Jean-Sébastien Liegey, David Calvet, Jean‐Claude Baron, Laure Bottin, Stephen Delorme, Jean Capron, Diana Doukhi, Sam Ghazanfari, David Weisenburger, Edwige Lescieux, Florent Gariel, Xavier Barreau, Patrice Ménégon, Thomas Tourdias, Catherine Oppenheim, Olivier Naggara, Titien Tuilier, Nader Sourour, Nader Sourour, Eimad Shotar, Stéphanie Lenck, Kévin Premat, Raphaël Blanc, Simon Escalard, Robert Fahed, Stanislas Smajda, Mikaël Mazighi
Abstract
<h3>Background and Objectives</h3> 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). <h3>Methods</h3> 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). <h3>Results</h3> 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%]; <i>p</i> > 0.99) despite a shorter median IVT to puncture time in directly admitted patients (38 [IQR 23–55] vs 86 [IQR 70–110] minutes; <i>p</i> < 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). <h3>Discussions</h3> 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. <h3>Classification of Evidence</h3> This study provides Class IV evidence that tenecteplase within 270 minutes of LVO-AIS increases the probability of functional independence.