Second-dose intravenous thrombolysis with tenecteplase in alteplase-resistant medium-vessel-occlusion strokes: A retrospective and comparative study.

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2024-12-01 Epub Date: 2024-06-03 DOI:10.1177/23969873241254936

Nicolas Chausson, Stéphane Olindo, François-Xavier Laborne, Manvel Aghasaryan, Pauline Renou, Djibril Soumah, Sabrina Debruxelles, Tony Altarcha, Mathilde Poli, Yann L'Hermitte, Sharmila Sagnier, Moussa Toudou-Daouda, Nana Rahamatou Aminou-Tassiou, Leila Bentamra, Narimane Benmoussa, Cosmin Alecu, Carole Imbernon, Léonard Smadja, Gary Ouanounou, François Rouanet, Igor Sibon, Didier Smadja

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引用次数: 0

Abstract

Introduction: In intracranial medium-vessel occlusions (MeVOs), intravenous thrombolysis (IVT) shows inconsistent effectiveness and endovascular interventions remains unproven. We evaluated a new therapeutic strategy based on a second IVT using tenecteplase for MeVOs without early recanalization post-alteplase.

Patients and methods: This retrospective, comparative study included consecutively low bleeding risk MeVO patients treated with alteplase 0.9 mg/kg at two stroke centers. One center used a conventional single-IVT approach; the other applied a dual-IVT strategy, incorporating a 1-h post-alteplase MRI and additional tenecteplase, 0.25 mg/kg, if occlusion persisted. Primary outcomes were 24-h successful recanalization for efficacy and symptomatic intracranial hemorrhage (sICH) for safety. Secondary outcomes included 3-month excellent outcomes (modified Rankin Scale score of 0-1). Comparisons were conducted in the overall cohort and a propensity score-matched subgroup.

Results: Among 146 patients in the dual-IVT group, 103 failed to achieve recanalization at 1 h and of these 96 met all eligible criteria and received additional tenecteplase. Successful recanalization at 24 h was higher in the 146 dual-IVT cohort patients than in the 148 single-IVT cohort patients (84% vs 61%, p < 0.0001), with similar sICH rate (3 vs 2, p = 0.68). Dual-IVT strategy was an independent predictor of 24-h successful recanalization (OR, 2.7 [95% CI, 1.52-4.88]; p < 0.001). Dual-IVT cohort patients achieved higher rates of excellent outcome (69% vs 44%, p < 0.0001). Propensity score matching analyses supported all these associations.

Conclusion: In this retrospective study, a dual-IVT strategy in selected MeVO patients was associated with higher odds of 24-h recanalization, with no safety concerns. However, potential center-level confounding and biases seriously limit these findings' interpretation.

Trial registration: ClinicalTrials.gov Identifier: NCT05809921.

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使用替奈替普酶对阿替普酶耐药的中血管闭塞性脑卒中进行第二剂量静脉溶栓治疗：一项回顾性比较研究。

导言：对于颅内中血管闭塞症（MeVOs），静脉溶栓（IVT）的疗效并不一致，而血管内介入治疗仍未得到证实。我们评估了一种新的治疗策略，即使用替奈替普酶（tenecteplase）进行第二次静脉溶栓治疗，以治疗阿替普酶治疗后没有早期再通畅的中血管闭塞症：这项回顾性比较研究包括在两家卒中中心连续接受阿替普酶 0.9 mg/kg 治疗的低出血风险 MeVO 患者。其中一个中心采用了传统的单IVT方法；另一个中心采用了双IVT策略，包括阿替普酶后1小时的磁共振成像，如果闭塞持续存在，则追加0.25 mg/kg的替奈替普酶。主要结果是24小时成功再通的疗效和无症状性颅内出血（sICH）的安全性。次要结果包括 3 个月的优秀结果（修改后的 Rankin 量表评分为 0-1）。比较结果在整个队列和倾向评分匹配亚组中进行：在双通道 IVT 组的 146 名患者中，103 人未能在 1 小时内实现再通畅，其中 96 人符合所有合格标准，接受了额外的替奈普酶治疗。146 名双 IVT 组患者在 24 小时内成功再通畅的比例高于 148 名单 IVT 组患者（84% 对 61%，P = 0.68）。双 IVT 策略是 24 小时成功再通畅的独立预测因素（OR，2.7 [95% CI，1.52-4.88]；P P 结论：在这项回顾性研究中，在选定的 MeVO 患者中采用双 IVT 策略可提高 24 小时再通的几率，且无安全性问题。然而，潜在的中心水平混杂因素和偏倚严重限制了这些研究结果的解释：试验注册：ClinicalTrials.gov Identifier：试验注册：ClinicalTrials.gov Identifier：NCT05809921。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.