Tenecteplase in practice: A rural tele-stroke network’s experience

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-08-06 DOI:10.1016/j.jstrokecerebrovasdis.2025.108416

Alexander Vorobyev MD (Neurology Chief Resident) , Marina Buciuc MD, MS (Neurology Resident) , Kevin Jacks BSN, MPA (Stroke Program Analyst) , Christina E. Blake BSN, RN, SCRN (Cerebrovascular Program System Director) , Marrissa Cobiella (Stroke Program Coordinator) , Sami Al Kasab MD (Associate Professor of Neurology) , Christine A. Holmstedt DO (Professor of Neurology) , Ghada A. Mohamed MD, MSc, MSCR (Assistant Professor of Neurology)

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引用次数: 0

Abstract

Background

Alteplase (tPA) and Tenecteplase (TNK) are both FDA-approved thrombolytic agents for acute ischemic stroke (AIS) treatment. While TNK showed efficacy and safety in the randomized clinical trials, its real-world utilization and effectiveness in rural populations remain key areas for post-approval evaluation. In August 2023 our academic institution, serving as a statewide telestroke network hub, implemented a system-wide transition from tPA to TNK. This study explores the real-world experience of this transition within a telestroke network in rural South Carolina.

Methods

This retrospective study analyzed data from the Medical University of South Carolina (MUSC) Telestroke Network (1 Hub, 16 spoke centers) on patients with confirmed AIS who received thrombolytics between 2022 and 2024. We compared outcomes between patients treated with tPA or TNK and performed subgroup analyses for LVO and spoke center patients. The analysis focused on safety, efficiency metrics, and functional outcomes. Categorical and continuous variables were assessed using Fisher’s exact and Wilcoxon rank-sum tests (p < 0.05).

Results

Among 1644 patients with discharge diagnosis of AIS, 302 (18 %) received thrombolytics: TNK (n = 144, 47.7 %) and tPA (n = 158, 52.3 %). Median door-to-needle times were similar (TNK 45 min vs. tPA 42 min, p = 0.6). No statistical differences were observed in symptomatic hemorrhage (4.2 % vs. 1.9 %, p = 0.32), discharge NIHSS, or hospital length of stay. Outcomes at spoke centers were comparable. In LVO transferred patients and treated at the hub, TNK was associated with fewer mechanical thrombectomy passes (median 1 vs. 2, p = 0.046) and higher rates of functional independence at discharge (mRS ≤3: 75.4 % vs. 54.4 %, p = 0.02).

Conclusions

The system-wide transition to TNK resulted in similar safety profiles and treatment times, with notable improvements in procedural efficiency and functional outcomes for patients with LVO. These findings support the broader adoption of TNK as a viable alternative to tPA in acute ischemic stroke management, particularly in telestroke networks and rural communities where staffing and infrastructure may be constrained.

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Tenecteplase在实践中的应用：农村远程卒中网络的经验。

背景：阿替普酶（tPA）和替奈普酶（TNK）都是fda批准的用于急性缺血性卒中（AIS）治疗的溶栓药物。虽然TNK在随机临床试验中显示出有效性和安全性，但其在农村人群中的实际应用和有效性仍然是批准后评估的关键领域。在2023年8月，我们的学术机构，作为全州的远程中风网络枢纽，实施了从tPA到TNK的全系统过渡。本研究探讨了在南卡罗来纳农村的远程中风网络中这种转变的现实世界经验。方法：这项回顾性研究分析了来自南卡罗来纳医科大学（MUSC）中风网络（1个中心，16个中心）的数据，这些数据来自2022年至2024年间接受溶栓治疗的确诊AIS患者。我们比较了接受tPA或TNK治疗的患者的结果，并对LVO和spoke center患者进行了亚组分析。分析的重点是安全性、效率指标和功能结果。使用Fisher精确和Wilcoxon秩和检验评估分类变量和连续变量(结果：在1644例出院诊断为AIS的患者中，302例（18%）接受溶栓治疗：TNK （n=144, 47.7%）和tPA （n=158, 52.3%）。门到针的中位时间相似（TNK 45分钟vs tPA 42分钟，p=0.6）。在症状性出血（4.2% vs. 1.9%, p=0.32）、出院NIHSS或住院时间方面均无统计学差异。辐条中心的结果具有可比性。在LVO转移并在中心治疗的患者中，TNK与较少的机械取栓次数（中位数1比2，p=0.046）和更高的出院功能独立性相关（mRS≤3:75.4%比54.4%,p=0.02）。结论：全系统向TNK的过渡产生了相似的安全性和治疗时间，并显著改善了LVO患者的程序效率和功能结局。这些发现支持在急性缺血性卒中管理中广泛采用TNK作为tPA的可行替代方案，特别是在人员和基础设施可能受到限制的中风网络和农村社区。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.