Fouzi Bala, William Diprose, Bijoy K Menon, Nishita Singh, Houman Khosravani, Aleksander Tkach, Luciana Catanese, Dariush Dowlatshahi, Thalia S Field, Gary Hunter, Tolulope Sajobi, Michael D Hill, Brian H Buck, Richard H Swartz, Mohammed A Almekhlafi
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We examined angiographic outcomes (extended final thrombolysis in cerebral infarction (eTICI) 2c-3 after first-pass, eTICI 2b-3 and eTICI 2 c-3 on final angiography), and clinical and safety outcomes. Mixed effect regression analyses with interaction terms were performed. All outcomes were assessed and analyzed by blinded adjudicators.</p><p><strong>Results: </strong>Among 506 patients who received thrombectomy, 435 were included (222 (51.0%) IV tenecteplase, 213 (49.0%) IV alteplase). A stent retriever was used as the first line endovascular thrombectomy (EVT) approach in 288 (66.2%), and aspiration in 147 (33.8%) patients. There was no difference in rates of final eTICI 2c-3 between groups (57.0% with stent retriever vs 61.9% with aspiration; P=0.35). There was, however, a significant interaction (P=0.02) between thrombolysis type and first line EVT strategy for final eTICI 2c-3, where tenecteplase was associated with higher odds of final eTICI 2c-3 with aspiration (adjusted OR (aOR) 2.29, 95% CI 1.10 to 4.75), but not with stent retriever (aOR 0.63, 95% CI 0.38 to 1.04). No significant interaction between thrombolysis and first line strategy was found for the other angiographic, clinical or safety outcomes.</p><p><strong>Conclusion: </strong>IV tenecteplase before EVT may enhance reperfusion with first line aspiration.</p><p><strong>Trial registration number: </strong>NCT03889249.</p>","PeriodicalId":16411,"journal":{"name":"Journal of NeuroInterventional Surgery","volume":" ","pages":""},"PeriodicalIF":4.5000,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effect of thrombolysis type on the efficacy of aspiration versus stent retriever first line thrombectomy: results from the AcT trial.\",\"authors\":\"Fouzi Bala, William Diprose, Bijoy K Menon, Nishita Singh, Houman Khosravani, Aleksander Tkach, Luciana Catanese, Dariush Dowlatshahi, Thalia S Field, Gary Hunter, Tolulope Sajobi, Michael D Hill, Brian H Buck, Richard H Swartz, Mohammed A Almekhlafi\",\"doi\":\"10.1136/jnis-2024-022268\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Intravenous (IV) tenecteplase is increasingly being used in lieu of alteplase for acute ischemic stroke. 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引用次数: 0
摘要
背景：越来越多的急性缺血性卒中患者使用静脉注射（IV）替尼采普酶代替阿替普酶。我们试图研究静脉注射替奈普酶与静脉注射阿替普酶对一线血栓切除策略疗效的影响：这是阿替普酶与替尼酶（AcT）试验的二次分析。我们纳入了尝试血栓切除术的前循环和后循环卒中患者。我们比较了支架回取器作为一线策略与单独接触抽吸的结果，以及与溶栓类型的交互作用。我们研究了血管造影结果（首次通过后的脑梗塞最终溶栓扩展指数（eTICI）2c-3、最终血管造影的 eTICI 2b-3 和 eTICI 2c-3）以及临床和安全性结果。进行了带有交互项的混合效应回归分析。所有结果均由盲人评审员进行评估和分析：在506例接受血栓切除术的患者中，有435例被纳入（222例（51.0%）静脉注射替奈普酶，213例（49.0%）静脉注射阿替普酶）。288例（66.2%）患者采用支架回取器作为一线血管内血栓切除术（EVT）方法，147例（33.8%）患者采用抽吸法。两组患者的最终 eTICI 2c-3 比率没有差异（支架回取器疗法为 57.0% ，抽吸疗法为 61.9%；P=0.35）。然而，溶栓类型和一线EVT策略对最终eTICI 2c-3有显著的交互作用（P=0.02），其中十肽酶与抽吸（调整OR (aOR) 2.29，95% CI 1.10至4.75）相关，而与支架回旋器（aOR 0.63，95% CI 0.38至1.04）无关。在其他血管造影、临床或安全性结果方面，溶栓与一线策略之间没有发现明显的交互作用：试验注册号：NCT03889249：试验注册号：NCT03889249。
Effect of thrombolysis type on the efficacy of aspiration versus stent retriever first line thrombectomy: results from the AcT trial.
Background: Intravenous (IV) tenecteplase is increasingly being used in lieu of alteplase for acute ischemic stroke. We sought to study the influence of IV tenecteplase versus IV alteplase on the efficacy of first line thrombectomy strategy.
Methods: This was a secondary analysis of the Alteplase versus Tenecteplase (AcT) trial. We included anterior and posterior circulation stroke patients in whom a thrombectomy was attempted. We compared outcomes for stent retriever as first line strategy versus contact aspiration alone, and interactions with thrombolysis type. We examined angiographic outcomes (extended final thrombolysis in cerebral infarction (eTICI) 2c-3 after first-pass, eTICI 2b-3 and eTICI 2 c-3 on final angiography), and clinical and safety outcomes. Mixed effect regression analyses with interaction terms were performed. All outcomes were assessed and analyzed by blinded adjudicators.
Results: Among 506 patients who received thrombectomy, 435 were included (222 (51.0%) IV tenecteplase, 213 (49.0%) IV alteplase). A stent retriever was used as the first line endovascular thrombectomy (EVT) approach in 288 (66.2%), and aspiration in 147 (33.8%) patients. There was no difference in rates of final eTICI 2c-3 between groups (57.0% with stent retriever vs 61.9% with aspiration; P=0.35). There was, however, a significant interaction (P=0.02) between thrombolysis type and first line EVT strategy for final eTICI 2c-3, where tenecteplase was associated with higher odds of final eTICI 2c-3 with aspiration (adjusted OR (aOR) 2.29, 95% CI 1.10 to 4.75), but not with stent retriever (aOR 0.63, 95% CI 0.38 to 1.04). No significant interaction between thrombolysis and first line strategy was found for the other angiographic, clinical or safety outcomes.
Conclusion: IV tenecteplase before EVT may enhance reperfusion with first line aspiration.
期刊介绍：
The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.
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