TY - JOUR
T1 - Intravenous alteplase versus tenecteplase in patients with acute posterior circulation strokes
T2 - A secondary analysis from the AcT randomized controlled trial
AU - Cimflova, Petra
AU - Alhabli, Ibrahim
AU - Bala, Fouzi
AU - Horn, MacKenzie
AU - Benali, Faysal
AU - Buck, Brian H.
AU - Catanese, Luciana
AU - Coutts, Prof Shelagh B·
AU - Khosravani, Houman
AU - Appireddy, Ramana
AU - Tkach, Aleksander
AU - Dowlatshahi, Dar
AU - Carpani, Federico
AU - Field, Thalia
AU - Hunter, Gary
AU - Hill, Prof· Michael D·
AU - Poppe, Alexandre Y·
AU - Ademola, Ayoola
AU - Shamy, Michel
AU - Sajobi, Tolulope T·
AU - Swartz, Richard H·
AU - Almekhlafi, Mohammed A·
AU - Menon, Prof Bijoy K·
AU - Singh, Nishita
N1 - Funding Information:
There was no finding for this post-hoc study. The AcT trial was supported by the Canadian Institutes of Health Research, Alberta Strategy for Patient Oriented Research Support Unit (grant numbers 419722 and 450890 ).
Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/11/1
Y1 - 2024/11/1
N2 - Objectives: There are limited data available demonstrating the safety and efficacy of intravenous tenecteplase versus alteplase in patients with acute ischemic stroke in the posterior circulation. Materials and methods: This is a post-hoc analysis of the Alteplase compared to Tenecteplase (AcT) pragmatic, phase 3, registry-linked randomized controlled trial. Patients with any posterior circulation vessel occlusion on baseline imaging were included. Study outcomes included 90-day modified Rankin Scale (mRS) 0-1, mRS 0-2, ordinal mRS, death within 90 days, 24 h symptomatic intracerebral haemorrhage (sICH) and successful reperfusion/recanalization. Mixed effects regression adjusting for age, sex and stroke severity was used to analyze differences in outcomes between patients administered tenecteplase vs. alteplase. Further, sensitivity analysis was conducted for basilar artery occlusion (BAO) alone. Results: Of 1577 patients, 136 (8.6 %, 77:alteplase, 59:tenecteplase) had posterior circulation stroke. Baseline characteristics were similar[median age 71 (IQR 60-81) vs. 72 (IQR 65-82) years, 57.1 % vs. 67.8 % males, median baseline NIHSS 7 (IQR 4-12) vs. 7 (IQR 4-16) in alteplase vs. tenecteplase arms, respectively]. 28 patients (20.6 %, 16:alteplase, 12:tenecteplase arm) underwent EVT. The median 90-120 days mRS was 2 (IQR 1-4). There were no differences between alteplase and tenecteplase for 90-d mRS 0-1 (adjRR 0.93;95 %CI 0.63-1.36), 90-day mRS 0-2 (adjRR 0.95; 95 %CI 0.72-1.26), sICH (RR 0.65; 95 %CI 0.06-7.02) and mortality (RR 1.21; 95 %CI 0.61-2.38). Successful reperfusion eTICI 2b-3 and successful recanalization rAOL 2b-3 was achieved in 23/28 (82 %, 12:alteplase, 11:tenecteplase) and in 16/28 (57 %, 14:alteplase, 12:tenecteplase), respectively. Similar results were seen in 31 patients (22.8 %) with BAO. Conclusion: Intravenous tenecteplase has a similar effect on outcome as alteplase, without increased safety concerns in patients with acute posterior circulation strokes.
AB - Objectives: There are limited data available demonstrating the safety and efficacy of intravenous tenecteplase versus alteplase in patients with acute ischemic stroke in the posterior circulation. Materials and methods: This is a post-hoc analysis of the Alteplase compared to Tenecteplase (AcT) pragmatic, phase 3, registry-linked randomized controlled trial. Patients with any posterior circulation vessel occlusion on baseline imaging were included. Study outcomes included 90-day modified Rankin Scale (mRS) 0-1, mRS 0-2, ordinal mRS, death within 90 days, 24 h symptomatic intracerebral haemorrhage (sICH) and successful reperfusion/recanalization. Mixed effects regression adjusting for age, sex and stroke severity was used to analyze differences in outcomes between patients administered tenecteplase vs. alteplase. Further, sensitivity analysis was conducted for basilar artery occlusion (BAO) alone. Results: Of 1577 patients, 136 (8.6 %, 77:alteplase, 59:tenecteplase) had posterior circulation stroke. Baseline characteristics were similar[median age 71 (IQR 60-81) vs. 72 (IQR 65-82) years, 57.1 % vs. 67.8 % males, median baseline NIHSS 7 (IQR 4-12) vs. 7 (IQR 4-16) in alteplase vs. tenecteplase arms, respectively]. 28 patients (20.6 %, 16:alteplase, 12:tenecteplase arm) underwent EVT. The median 90-120 days mRS was 2 (IQR 1-4). There were no differences between alteplase and tenecteplase for 90-d mRS 0-1 (adjRR 0.93;95 %CI 0.63-1.36), 90-day mRS 0-2 (adjRR 0.95; 95 %CI 0.72-1.26), sICH (RR 0.65; 95 %CI 0.06-7.02) and mortality (RR 1.21; 95 %CI 0.61-2.38). Successful reperfusion eTICI 2b-3 and successful recanalization rAOL 2b-3 was achieved in 23/28 (82 %, 12:alteplase, 11:tenecteplase) and in 16/28 (57 %, 14:alteplase, 12:tenecteplase), respectively. Similar results were seen in 31 patients (22.8 %) with BAO. Conclusion: Intravenous tenecteplase has a similar effect on outcome as alteplase, without increased safety concerns in patients with acute posterior circulation strokes.
KW - Basilar artery occlusion
KW - Intravenous thrombolysis
KW - Posterior circulation stroke
KW - Tenecteplase
U2 - 10.1016/j.jstrokecerebrovasdis.2024.107985
DO - 10.1016/j.jstrokecerebrovasdis.2024.107985
M3 - Article
SN - 1052-3057
VL - 33
JO - Journal of Stroke & Cerebrovascular Diseases
JF - Journal of Stroke & Cerebrovascular Diseases
IS - 11
M1 - 107985
ER -