Effect of Intravenous Tenecteplase Dose on Cerebral Reperfusion Before Thrombectomy in Patients With Large Vessel Occlusion Ischemic Stroke

作者：Bruce Campbell, Peter Mitchell, Leonid Churilov, Nawaf Yassi, Timothy Kleinig, Richard Dowling, Bernard Yan, Steven Bush, Vincent Thijs, Rebecca Scroop, Marion Simpson, Mark Brooks, Hamed Asadi, Teddy Y. Wu, Darshan Shah, Tissa Wijeratne, Henry Zhao, Fana Alemseged, Felix Ng, Peter Bailey, Henry E. Rice, Laetitia de Villiers, Helen M. Dewey, Philip Choi, Helen Brown, Kendal Redmond, David Leggett, John Fink, Wayne Collecutt, Thomas Kræmer, Martín Krause, Dennis Cordato, Deborah Field, Henry Ma, Bill O’Brien, Benjamin Clissold, Ferdinand Miteff, Anna Clissold, Geoffrey Cloud, Leslie Bolitho, Luke Bonavia, Arup Bhattacharya, A. A. Wright, Abul Mamun, Fintan O’Rourke, John Worthington, Andrew Wong, Christopher Levi, Christopher F. Bladin, Gagan Sharma, Patricia Desmond, Mark Parsons, Geoffrey A. Donnan, Stephen M. Davis, EXTEND-IA TNK Part 2 investigators, James A. Taylor, Craig Kurunawai, Edmund Cheong, Anna Balabanski, Michael J. Waters, Jackson Harvey, Lavenia Cagi, Nicholas Chia, Anthony Khoo, Roy Drew, Jennifer Cranefield, Thomas J. Oxley, Cameron Williams, Edrich Rodrigues, Patrick Salvaris, Angela Dos Santos, Jo-Lyn Ng, Skye Coote, Carolyn Beltrame, Elizabeth A. Mackey, Kanaga Lagma, Amy McDonald, David M. Jackson, Jessica Tsoleridis, Lauren Pesavento, Ashu Jhamb, Amy Brodtmann, Alexandra Warwick, Bronwyn Coulton, Dennis Young, Justin Whitley, Carol Bendall, Hans T.H. Tu, Sherisse Celestino, Essie Low, Arman Sabet, Sachin Mishra, Berzenn Urbi, Tanya Frost, Jessie Chen, Siew Kar Chen, Melissa Y Tang, Kara Nowak, Rodrigo Pereira Martins, Channa Senanayake, Charmaine Yam, Daniel Barber, Francesca Bridge, Joseph Wong, Grace Thomas, Jennifer Liu, Naila Pachani, Rose Lee, Ramesh Sahathevan, Casey Hair, Timothy Harrington, Brendan Steinfort, Kenneth Faulder, Susan Day, Allan J McDougall, Cecilia Cappelen‐Smith, Jason Wenderoth, Andrew Cheung, Nathan Manning, Andrew Moey, Vanessa Maxwell, Thanh G. Phan, Shaloo Singhal, John Ly, Winston Chong, Ronil V. Chandra, Lee‐Anne Slater, James Evans, Deborah Alchin, Paul Talman, Cameron Shaw, Abhishek Malhotra, Rohitha Makonahalli, Neil J. Spratt, Carlos García-Esperón, Lara Kaauwai, Patrick Groot, Anoop Madan, Carlos Chung, Andrea Moore, Robert Krones, Nancy Bilkhu, Helen Haines, Franz Eversheim, Erin Ray, Tessa Coupland, Timothy Ang, Stephen L. Winters, David Brunacci, Geoffrey Parker, Kylie Tastula, Claire Muller, Alan Coulthard, John Clouston, Ken Mitchell, Kate Mahady, Yvonne Liu, Ye Min Kuang, Aileen Wu, Karen Smith, Michael Stephenson, Emily Andrew, Matthew Ligtermoet, Matthew Lee-Archer, John Fink, James Beharry, Andrew Laing, Martin Krauß, Jane Eagle, Gerhard Uys, Lauren Arthurson, Krishna Mandaleson, Anne Van Berkel, Rohan Grimley, Wayne Skoien, Neil Mahant, P. Alan Barber, Ben McGuinness, Ayton Hope, Stefan Brew, Maurice Moriarty, Lily Zhao, Michele Sallaberger, Barry Snow, John Kolbe, R. Stark, John T. King, Richard Macdonnell, John Attia, Cate D’Este · 发表于：JAMA · 年份：2020 · DOI：10.1001/jama.2020.1511 · 被引用次数：266 · 研究领域：Acute Ischemic Stroke Management、Stroke Rehabilitation and Recovery、Intracerebral and Subarachnoid Hemorrhage Research

Importance: Intravenous thrombolysis with tenecteplase improves reperfusion prior to endovascular thrombectomy for ischemic stroke compared with alteplase. Objective: To determine whether 0.40 mg/kg of tenecteplase safely improves reperfusion before endovascular thrombectomy vs 0.25 mg/kg of tenecteplase in patients with large vessel occlusion ischemic stroke. Design, Setting, and Participants: Randomized clinical trial at 27 hospitals in Australia and 1 in New Zealand using open-label treatment and blinded assessment of radiological and clinical outcomes. Patients were enrolled from December 2017 to July 2019 with follow-up until October 2019. Adult patients (N = 300) with ischemic stroke due to occlusion of the intracranial internal carotid, \basilar, or middle cerebral artery were included less than 4.5 hours after symptom onset using standard intravenous thrombolysis eligibility criteria. Interventions: Open-label tenecteplase at 0.40 mg/kg (maximum, 40 mg; n = 150) or 0.25 mg/kg (maximum, 25 mg; n = 150) given as a bolus before endovascular thrombectomy. Main Outcomes and Measures: The primary outcome was reperfusion of greater than 50% of the involved ischemic territory prior to thrombectomy, assessed by consensus of 2 blinded neuroradiologists. Prespecified secondary outcomes were level of disability at day 90 (modified Rankin Scale [mRS] score; range, 0-6); mRS score of 0 to 1 (freedom from disability) or no change from baseline at 90 days; mRS score of 0 to 2 (functi...