Does Tenecteplase Before Mechanical Thrombectomy Result in a Faster Revascularization as Compared to Alteplase? Observations From a Comprehensive Stroke Care Center in Southern India

G. Kuruttukulam, K. Sundar, Lomesh B Bhirud, Ajay Panwar, Paul J. Alapatt
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Abstract

Background The Indian data concerning the endovascular mechanical thrombectomy (MT) in acute ischemic strokes (AIS) with large vessel occlusion (LVO) is still scarce and evolving. Tenecteplase (TNK) has been recently approved for intravenous stroke thrombolysis prior to the MT. Methods This study is a single-center retrospective study. We performed data analysis of the AIS patients who consecutively presented during the study period with LVO and underwent thrombectomy. Procedural success was defined by the post-thrombectomy angiographic picture of grades 2b and 3 on modified Thrombolysis in Cerebral Infarction (mTICI) scale. Primary efficacy outcome was defined as an improvement of ≥4 points in National Institute of Health Stroke Scale (NIHSS) score at 24 h. Secondary efficacy outcome was based on modified Rankin Scale (mRS) score at 90 days. We also performed a comparative analysis of TNK and alteplase subgroups. Results Successful recanalization (mTICI 2b/3) was achieved in 65 (86.67%) patients. There was a significant mean difference between the NIHSS scores on admission and at 24 h (P < .001). Likewise, mRS score at 3 months also showed a significant mean difference as compared to baseline (P < .001). A faster recanalization was observed in those who were thrombolyzed with TNK, needed fewer number of passes, and if the procedure was performed under conscious sedation. Conclusion This study further strengthens the Indian data on efficacy and safety of MT in LVO ischemic strokes. Besides, whether the observation of TNK resulting in a faster revascularization is due to some factors unaccounted in our study, or an actual effect on thrombus due to a high fibrin specificity, needs to be tested further in larger randomized studies with matched sample sizes.
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与阿替普酶相比,机械取栓前使用替普酶能更快地重建血管吗?来自印度南部一个综合中风护理中心的观察
印度关于血管内机械取栓术治疗急性缺血性中风(AIS)合并大血管闭塞(LVO)的资料仍然很少,而且还在不断发展。Tenecteplase (TNK)最近在MT之前被批准用于静脉卒中溶栓。我们对研究期间连续出现LVO并行血栓切除术的AIS患者进行了数据分析。手术成功的定义是取栓后血管造影图像在改良脑梗死溶栓(mTICI)评分中达到2b级和3级。主要疗效指标定义为24 h时美国国立卫生研究院卒中量表(NIHSS)评分改善≥4分。次要疗效指标基于90天的改良Rankin量表(mRS)评分。我们还对TNK和阿替普酶亚组进行了比较分析。结果65例(86.67%)患者成功再通(mTICI 2b/3)。入院时和入院24 h时NIHSS评分的平均差异有统计学意义(P < 0.001)。同样,与基线相比,3个月时的mRS评分也显示出显著的平均差异(P < 0.001)。在使用TNK溶栓的患者中,如果在清醒镇静下进行手术,则需要较少的通道次数,可以观察到更快的再通。结论本研究进一步强化了印度关于MT治疗LVO缺血性脑卒中疗效和安全性的研究数据。此外,观察到TNK导致更快的血运重建是由于我们研究中未考虑的一些因素,还是由于纤维蛋白的高特异性而对血栓产生的实际影响,需要在更大规模的匹配样本量的随机研究中进一步验证。
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