Tenecteplase versus Alteplase and First-Pass Reperfusion in Endovascular Thrombectomy

作者：William K. Diprose, Fouzi Bala, Bijoy K. Menon, Nishita Singh, Houman Khosravani, Aleksander Tkach, Ramana Appireddy, MacKenzie Horn, Luciana Catanese, Dar Dowlatshahi, Thalia S. Field, Gary R. Hunter, Tolulope T. Sajobi, Michael D. Hill, Brian Buck, Richard H. Swartz, Mohammed Almekhlafi · 发表于：American Journal of Neuroradiology · 年份：2025 · DOI：10.3174/ajnr.a8763 · 被引用次数：4 · 研究领域：Acute Ischemic Stroke Management、Peripheral Artery Disease Management、Intracerebral and Subarachnoid Hemorrhage Research

BACKGROUND AND PURPOSE: It is unknown whether thrombolysis with IV tenecteplase before endovascular thrombectomy (EVT) influences the probability of first-pass reperfusion when compared with IV alteplase. Therefore, we evaluated the effect of IV thrombolytic choice on this outcome. MATERIALS AND METHODS: We investigated the effects of thrombolytic agent (IV tenecteplase or IV alteplase) on first-pass reperfusion in EVT patients from the Alteplase Compared to Tenecteplase in Patients with Acute Ischemic Stroke (AcT) trial. The primary outcome was first-pass reperfusion, defined as expanded Thrombolysis in Cerebral Infarction (eTICI) score 2c-3 with a single thrombectomy pass. Secondary outcomes were modified first-pass reperfusion (eTICI 2b-3 after 1 pass), final eTICI score, total number of thrombectomy passes, and time from arterial access to successful reperfusion. Univariable models and generalized linear mixed-effects models with a logit link function were constructed. RESULTS: Among the 506 patients who underwent EVT in the AcT trial, 445 patients were included (230 [51.7%] women; median [interquartile range {IQR}] age, 73 [63–81]). Two hundred twenty-six (50.8%) received IV tenecteplase and 219 patients received IV alteplase (49.2%). First-pass reperfusion and modified first-pass reperfusion was achieved in 169 (38.0%) and 245 (55.1%) patients, respectively. First-pass reperfusion was achieved in 79 (35.0%) IV tenecteplase and 90 (41.1%) IV alteplase patients ( P ...