Intravenous thrombolysis with tenecteplase versus alteplase in acute ischemic stroke tandem occlusions: a systematic review and meta-analysis of current available literature.

IF 2.3 3区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Thrombosis and Thrombolysis Pub Date : 2025-03-13 DOI:10.1007/s11239-025-03084-4
Ocílio Ribeiro Gonçalves, Márcio Yuri Ferreira, Gabriel de Almeida Monteiro, Victor Gonçalves Soares, Luiza G Schmitt, Sávio Batista, Luís O S Nogueira, Christian Ken Fukunaga, João Victor Araújo de Oliveira, João de Deus Costa Alves, Kelson James Almeida
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Abstract

Tandem occlusions, characterized by the simultaneous occurrence of both extracranial and ipsilateral intracranial arterial occlusions, represents a challenging subset of large vessel occlusion (LVO) strokes. Currently, the treatment choice for tandem infarcts involves intravenous thrombolysis (IVT) followed by endovascular thrombectomy (EVT). In current literature, direct head-to-head comparisons between Alteplase and Tenecteplase for IVT in patients with tandem occlusions remain limited. The goal of this systematic review and meta-analysis is to synthesize the currently available data comparing the efficacy and safety profiles of alteplase and tenecteplase specifically in patients with tandem occlusions. We systematically searched PubMed, Embase and Cochrane from inception to June 2024 for studies enrolling patients with tandem lesions in acute ischemic stroke (AIS) treated with IVT involving Tenecteplase or Alteplase. The primary outcomes of interest were (1) modified Rankin Scale (mRS) 0-1, (2) modified Rankin Scale (mRS) 0-2, (3) successful recanalization (TICI 2b-3), (4) symptomatic intracranial hemorrhage (sICH) and (5) overall mortality. We compared the results using Risk Ratio (RR) with 95% Confidence Intervals (CI). A random effects model was applied for all outcomes. The Mantel-Haenszel method was used to pool results from individual studies. We also used I2 statistics and Cochran Q test to verify heterogeneity. Three studies published between 2023 and 2024 were included, two randomized controlled trials (RCTs) and one observational study, comprising 917 patients. Tenecteplase was administered for 230 (25,1%) patients. The age ranged from 57 to 82 years, the baseline NIHSS ranged from 10 to 24 points and there were 314 (34.2%) female patients in total. There was no statistically significant difference between groups for the outcomes of mRS 0-1 (RR 0.80; 95% CI 0.35 to 1.83; p = 0.597; I2 = 86%), mRS 0-2 (RR 1.04; 95% CI 0.88 to 1.23; p = 0.630; I2 = 0%), TICI 2b-3 (RR 1.00; 95% CI 0.93 to 1.09; p = 0.909; I2 = 0%), sICH (RR 1.09; 95% CI 0.64 to 1.84; p = 0.756; I2 = 0%), and overall mortality (RR 0.68; 95% CI 0.45 to 1.05; p = 0.081; I2 = 17%). This meta-analysis found that tenecteplase achieved similar outcomes to alteplase in improving functional outcomes and recanalization rates. Additionally, there was no significant difference between tenecteplase and alteplase in terms of rates of sICH and mortality. Further large-scale randomized studies are urgently needed to provide a definitive conclusion on the comparative efficacy and safety of tenecteplase versus alteplase in tandem occlusions.

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串联闭塞的特点是颅外动脉闭塞和同侧颅内动脉闭塞同时发生,是大血管闭塞性脑卒中(LVO)中极具挑战性的一种。目前,治疗串联梗死的方法包括静脉溶栓(IVT)和血管内血栓切除术(EVT)。在目前的文献中,对串联闭塞患者进行静脉溶栓治疗时使用 Alteplase 和 Tenecteplase 的直接正面比较仍然有限。本系统综述和荟萃分析的目的是综合现有数据,比较阿替普酶和替奈普酶在串联闭塞患者中的疗效和安全性。我们系统检索了 PubMed、Embase 和 Cochrane 上从开始到 2024 年 6 月的研究,这些研究纳入了使用替奈普酶或阿替普酶进行 IVT 治疗的急性缺血性卒中(AIS)串联病变患者。主要研究结果包括:(1) 改良 Rankin 量表(mRS)0-1;(2) 改良 Rankin 量表(mRS)0-2;(3) 成功再通(TICI 2b-3);(4) 症状性颅内出血(sICH);(5) 总死亡率。我们使用风险比 (RR) 和 95% 置信区间 (CI) 对结果进行了比较。所有结果均采用随机效应模型。曼特尔-海恩泽尔法用于汇总单个研究的结果。我们还使用了 I2 统计量和 Cochran Q 检验来验证异质性。共纳入了三项发表于2023年至2024年的研究,其中两项为随机对照试验(RCT),一项为观察性研究,共纳入917名患者。230名(25.1%)患者接受了替奈普酶治疗。患者年龄从 57 岁到 82 岁不等,基线 NIHSS 从 10 分到 24 分不等,共有 314 名(34.2%)女性患者。在 mRS 0-1 (RR 0.80; 95% CI 0.35 to 1.83; p = 0.597; I2 = 86%), mRS 0-2 (RR 1.04; 95% CI 0.88 to 1.23; p = 0.630; I2 = 0%)、TICI 2b-3 (RR 1.00; 95% CI 0.93 to 1.09; p = 0.909; I2 = 0%)、sICH (RR 1.09; 95% CI 0.64 to 1.84; p = 0.756; I2 = 0%)和总死亡率 (RR 0.68; 95% CI 0.45 to 1.05; p = 0.081; I2 = 17%)。这项荟萃分析发现,在改善功能预后和再通率方面,替奈普酶与阿替普酶取得了相似的结果。此外,在 sICH 和死亡率方面,替奈替普酶和阿替普酶没有明显差异。目前亟需进一步开展大规模随机研究,以便就替奈普酶与阿替普酶在串联闭塞中的疗效和安全性对比得出明确结论。
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来源期刊
CiteScore
9.20
自引率
0.00%
发文量
112
审稿时长
4-8 weeks
期刊介绍: The Journal of Thrombosis and Thrombolysis is a long-awaited resource for contemporary cardiologists, hematologists, vascular medicine specialists and clinician-scientists actively involved in treatment decisions and clinical investigation of thrombotic disorders involving the cardiovascular and cerebrovascular systems. The principal focus of the Journal centers on the pathobiology of thrombosis and vascular disorders and the use of anticoagulants, platelet antagonists, cell-based therapies and interventions in scientific investigation, clinical-translational research and patient care. The Journal will publish original work which emphasizes the interface between fundamental scientific principles and clinical investigation, stimulating an interdisciplinary and scholarly dialogue in thrombosis and vascular science. Published works will also define platforms for translational research, drug development, clinical trials and patient-directed applications. The Journal of Thrombosis and Thrombolysis'' integrated format will expand the reader''s knowledge base and provide important insights for both the investigation and direct clinical application of the most rapidly growing fields in medicine-thrombosis and vascular science.
期刊最新文献
Recanalization is more important than procedure time on outcome of thrombectomy in acute vertebrobasilar artery occlusion. Intravenous thrombolysis with tenecteplase versus alteplase in acute ischemic stroke tandem occlusions: a systematic review and meta-analysis of current available literature. Immune checkpoint inhibitors and myocardial infarction. Incidence of arterial and venous thromboembolism in cancer patients- insights from more than 5,000,000 patients. Predictors of venous thromboembolic events in hospitalized patients with COVID-19.
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