Safety and Efficacy of Tenecteplase Compared With Alteplase in Patients With Large Vessel Occlusion Stroke

作者：Fouzi Bala, Nishita Singh, Brian Buck, Ayoola Ademola, Shelagh B. Coutts, Yan Deschaintre, Houman Khosravani, Ramana Appireddy, F. Moreau, Stephen Phillips, Gord Gubitz, Aleksander Tkach, Luciana Catanese, Dar Dowlatshahi, George Medvedev, Jennifer Mandzia, Aleksandra Pikula, Jai Shankar, Heather Williams, Thalia S. Field, Alejandro Manosalva Alzate, Muzaffar Siddiqui, Atif Zafar, Oje Imoukhoude, Gary Hunter, Ibrahim Alhabli, Faysal Benali, MacKenzie Horn, Michael D. Hill, Michel Shamy, Tolulope T. Sajobi, Richard H. Swartz, Bijoy K. Menon, Mohammed Almekhlafi · 发表于：JAMA Neurology · 年份：2023 · DOI：10.1001/jamaneurol.2023.2094 · 被引用次数：69 · 研究领域：Acute Ischemic Stroke Management、Stroke Rehabilitation and Recovery、Intracerebral and Subarachnoid Hemorrhage Research

Importance: It is unknown whether intravenous thrombolysis using tenecteplase is noninferior or preferable compared with alteplase for patients with acute ischemic stroke. Objective: To examine the safety and efficacy of tenecteplase compared to alteplase among patients with large vessel occlusion (LVO) stroke. Design, Setting, and Participants: This was a prespecified analysis of the Intravenous Tenecteplase Compared With Alteplase for Acute Ischaemic Stroke in Canada (ACT) randomized clinical trial that enrolled patients from 22 primary and comprehensive stroke centers across Canada between December 10, 2019, and January 25, 2022. Patients 18 years and older with a disabling ischemic stroke within 4.5 hours of symptom onset were randomly assigned (1:1) to either intravenous tenecteplase or alteplase and were monitored for up to 120 days. Patients with baseline intracranial internal carotid artery (ICA), M1-middle cerebral artery (MCA), M2-MCA, and basilar occlusions were included in this analysis. A total of 1600 patients were enrolled, and 23 withdrew consent. Exposures: Intravenous tenecteplase (0.25 mg/kg) vs intravenous alteplase (0.9 mg/kg). Main Outcomes and Measures: The primary outcome was the proportion of modified Rankin scale (mRS) score 0-1 at 90 days. Secondary outcomes were an mRS score from 0 to 2, mortality, and symptomatic intracerebral hemorrhage. Angiographic outcomes were successful reperfusion (extended Thrombolysis in Cerebral Infarction scale score 2b...