Tenecteplase Thrombolysis for Stroke up to 24 Hours After Onset With Perfusion Imaging Selection: The CHABLIS-T II Randomized Clinical Trial

作者：Xin Cheng, Lan Hong, Longting Lin, Leonid Churilov, Yifeng Ling, Nan Yang, Jianliang Fu, Guozhi Lu, Yunhua Yue, Jin Zhang, Feng Wang, Ziran Wang, Yanxin Zhao, Xiaoyu Zhou, Zhaolong Peng, Danhong Wu, Liandong Zhao, Qijin Zhai, Xiaofei Yu, Qi Fang, Xiangzhong Shao, Ying Tang, Diwen Zhang, Yu Geng, Yue Zhang, Bosheng Fan, Bing Zhang, Congguo Yin, Yangmei Chen, Yiran Zhang, Xinyu Liu, Siyuan Li, Lumeng Yang, Mark Parsons, Qiang Dong, Mark Parsons, Jiali Xu, Suling Xie, Cheng Liu, Dan Han, Christopher Levi, David Wang, Elizabeth Holiday, Wenjie Cao, Kun Fang, Yi Dong, Liang Ge, Ying Guo, Deyun Wang, Caixia Xiao, Dena Li, Jinghuai Feng, Zhuangying Luo, Wen Yang, Lian Chen, Li Cao, Yuwu Zhao, Jiangshan Deng, Dan Li, Rigele Te, Zidian Jiang, G Ye, Fuhou Zhu, Yongmei Pan, Amuguleng Chaoge, Zitong Qi, Xiangchao Li, Ling Yu, Xinxin Tian, Lianjing Kang, Jian Wang, Yaoyan Shen, Jiying Dai, X. Li, Yuxin Zhang, Jie Bai, Nan Li, Ya Su, Liying Yao, Qingxu Jia, Liyan Guo, Yingying Li, Haifeng Sang, Lihua Zhao, Yujuan Lu, Chunxue Zhu, Liang‐Hao Hu, Youmei Li, Lingyun Liu, Xiaoqiong Zhu, XU Shu-kun, Yu‐Ming Kong, Zhiwen Yao, Hui Xu, Xiaoguang Zhang, Jie Xue, Yanting Ma, Shuhua Chen, Zhiwen Wan, Ying Ding, Zhi-Zhang Li, Xiankai Cui, Ping Wang, Shanshan Jiang, Dong Zhang, Hong‐Xian Sun, Xiaoli Feng, Yaqiong Wang, Chunlin Ma, Tiandong Wang, Shaoshuai Wang, Zuopeng Li, Jun Li, Xiafei Wang, Guangjian Zhao, Yanxue Gong, Shirui Zhang, Liquan Wang, Xueyuan Liu, Quanbin Zhang, Xiang Zhang, Jiping Sun, You Lü, He Huang, Li Gong, Yuchen Zhou, Siyu Qian, Wenjian Li, Rui Shen, Yi Xu, Jingjing Zhao, Wu Guang, Bing Liu, Yuedong Chen, Zhan Shen, Yuan Miao, Hongtao Chen, Lukuang Qiao, Sun Jin, Weijie Chen, Wenpeng Liu, Liwei Shen, Xiaoli Yang, Yonghui Shi, Qiang Chen, Jisha Tian, Fan Gong, Juehua Zhu, Bin Zhou, Dongxue Ding, Kangxiang Ji, Jinglei Wang, Junfeng Gao, Xiaoli Yang, Hua Mei, Xiaojin Chen, Weiwei Wu, Jing Xue, Jing Wang, Hongwei Sun, Yun Zhai, Guang Zhang, Yanyan Sun, Fang Li, Hongwei Sun, Ran Wei, Weina Zhang, Xinyao Wang, Xin Zou, You Ren, Feihu Cao, Gaoping Lin, Gang Li, Zhengyu Huang, Qianqian Qiu, Xuehong Cheng, Xiaoxi Zhang, Zhiduo Cai, Ranran Xin, Dandan Liu, Jingjing Zhao, Zhenchan Lu, Xuanfei Jiang, Keqin Liu, Xiong Zhang, L. H. Mo, Yuqing Zhang · 发表于：Stroke · 年份：2025 · DOI：10.1161/strokeaha.124.048375 · 被引用次数：43 · 研究领域：Acute Ischemic Stroke Management、Antiplatelet Therapy and Cardiovascular Diseases、Intracerebral and Subarachnoid Hemorrhage Research

BACKGROUND: Whether it is effective and safe to extend the time window of intravenous thrombolysis up to 24 hours after the last known well is unknown. We aimed to determine the efficacy and safety of tenecteplase in Chinese patients with acute ischemic stroke due to large/medium vessel occlusion within an extended time window. METHODS: Patients with ischemic stroke presenting 4.5 to 24 hours from the last known well, with a favorable penumbral profile and an associated large/medium vessel occlusion, were randomized 1:1 to either 0.25 mg/kg tenecteplase or the best medical treatment. A favorable penumbral profile was defined as a hypoperfusion lesion volume to infarct core volume ratio >1.2, with an absolute volume difference >10 mL, and an ischemic core volume <70 mL. The primary outcome was the achievement of major reperfusion without symptomatic intracranial hemorrhage within 24 to 48 hours post-randomization. Major reperfusion was defined as the restoration of blood flow of >50% of the involved ischemic territory. Secondary outcomes included recanalization, infarct growth, major neurological improvements, change in the National Institutes of Health Stroke Scale score, hemorrhagic transformation within 24 to 48 hours, systemic bleeding at discharge, and modified Rankin Scale (score 0–1, score 0–2, score 5–6, and modified Rankin Scale distribution) at 90 days. The comparison of the primary outcome between groups was conducted using modified Poisson regression wi...