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

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

Edité par CCSD ; American Academy of Neurology -

International audience. Objective: 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 a 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 [NIHSS] score 16 [IQR 10-20]), of which 520 (88%) were secondarily transferred after IVT. Functional independence occurred in 47% (n = 269/570; 95%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 > .99) despite a shorter median IVT-to-puncture time in directly admitted patients (38 [IQR 23-55] vs 86 [IQR 70-110] minutes; p < .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).Conclusions: 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 is increases the probability of functional independence.

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