Manvel AGHASARYAN (France)
Centre Hospitalier Sud Francilien NeurologyAuthor Of 1 Presentation
INTRAVENOUS THROMBOLYSIS WITH TENECTEPLASE BEFORE MECHANICAL TROMBECTOMY FOR ACUTE ISCHEMIC STROKE
Abstract
Group Name
on behalf the TETRIS Investigators
Background And Aims
In clinical trials, intravenous thrombolysis (IVT) with tenecteplase improved recanalization before mechanical thrombectomy (MT) patients with large vessel occlusion acute ischemic strokes (LVO-AIS) compared with alteplase. In this study we investigated in routine care the efficacy and safety of IVT with tenecteplase prior to MT in patients with LVO-AIS, either transferred after IVT (drip-and-ship) or who underwent MT on site (mothership).
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 (mRS score ≤ 2). Recanalization (mTICI score 2b-3), was evaluated before (pre-MT) and after MT (final).
Results
We included 590 patients (median age 75 years [IQR 61-84]; 316 women [54%]; median NIHSS score 16 [IQR 10-19]), of which 522 (88%) were treated under the drip-and-ship paradigm. Functional independence occurred in 47% (n = 268/572; 95%CI 42.7-51.0) of patients. Pre-MT recanalization occurred in 121 patients (20.5%; 95%CI 17.3-24.0), at a similar rate across treatment paradigms (mothership, n = 17/68 [25%]; drip-and-ship, n = 104/522 [20%]; p = .34) despite a shorter median IVT-to-puncture time in mothership patients (38 [IQR 23-55] vs 89 [IQR 71-110] minutes; p < .001). Final recanalization was achieved in 496 patients (84%; 95%CI 80.9-86.9). Symptomatic intracerebral hemorrhage occurred in 14 patients (2%; 95%CI 1.4-4.1).
Conclusions
Tenecteplase before MT is safe, effective and achieves a fast recanalization in everyday practice under drip-and-ship and mothership treatment paradigms, in line with published results. These findings should encourage its wider use in bridging therapy.
Trial Registration Number
Not applicable