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. 2021 Nov 30;97(22):e2173-e2184.
doi: 10.1212/WNL.0000000000012915. Epub 2021 Oct 11.

Functional Outcome, Recanalization, and Hemorrhage Rates After Large Vessel Occlusion Stroke Treated With Tenecteplase Before Thrombectomy

Gaspard Gerschenfeld  1 , Didier Smadja  1 , Guillaume Turc  1 , Stephane Olindo  1 , François-Xavier Laborne  1 , Marion Yger  1 , Jildaz Caroff  1 , Bruno Gonçalves  1 , Pierre Seners  1 , Marie Cantier  1 , Yann l'Hermitte  1 , Manvel Aghasaryan  1 , Cosmin Alecu  1 , Gaultier Marnat  1 , Wagih Ben Hassen  1 , Erwah Kalsoum  1 , Frédéric Clarençon  1 , Michel Piotin  1 , Laurent Spelle  1 , Christian Denier  1 , Igor Sibon  1 , Sonia Alamowitch  1 , Nicolas Chausson  2 ; TETRIS Study Group
Collaborators, Affiliations

Functional Outcome, Recanalization, and Hemorrhage Rates After Large Vessel Occlusion Stroke Treated With Tenecteplase Before Thrombectomy

Gaspard Gerschenfeld et al. Neurology. .

Abstract

Background and objectives: 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).

Methods: 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).

Results: 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%]; 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).

Discussions: 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.

Classification of evidence: This study provides Class IV evidence that tenecteplase within 270 minutes of LVO-AIS increases the probability of functional independence.

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