Tenecteplase 与 Alteplase 在中血管闭塞缺血性脑卒中中的应用：Alteplase 与 Tenecteplase 随机试验的二次分析。

IF 6 1区医学 Q1 CLINICAL NEUROLOGY Journal of Stroke Pub Date : 2024-05-01 Epub Date: 2024-05-30 DOI:10.5853/jos.2023.03713

Fouzi Bala, Nishita Singh, Katrina Ignacio, Ibrahim Alhabli, Ayoola Ademola, Anas Alrohimi, Houman Khosravani, Aleksander Tkach, Luciana Catanese, Dariush Dowlatshahi, Thalia Field, Gary Hunter, Faysal Benali, MacKenzie Horn, Andrew Demchuk, Michael Hill, Tolulope Sajobi, Brian Buck, Richard Swartz, Mohammed Almekhlafi, Bijoy K Menon

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引用次数: 0

摘要

背景和目的：对于中血管闭塞（MeVO）导致的缺血性卒中患者，替奈替普酶的安全性和有效性尚未得到充分研究。我们旨在比较替奈普酶和阿替普酶对中血管闭塞所致中风的治疗效果：方法：纳入阿尔替普酶与替奈普酶（AcT）比较试验的基线M2-大脑中动脉（MCA）、M3/M4-MCA、P2/P3/P4-大脑后动脉（PCA）、A2/A3/A4-大脑前动脉（ACA）闭塞患者。主要结果是90天改良Rankin量表（mRS）0-1的比例。次要结果为 90 天 mRS 0-2、顺序 mRS、死亡率、生活质量测量（EuroQol 5-Dimension 5-Level、EuroQol 视觉模拟量表）和症状性脑出血（sICH）。报告了接受血管内血栓切除术（EVT）的患者最初和最后成功再灌注的情况：在1558名有基线计算机断层扫描血管造影的患者中，455人（29.2%）患有MeVO，其中27.5%（125/455）为近端M2；16.3%（74/455）为远端M2；35.2%（160/455）为M3/M4；7.5%（34/455）为A2/A3/A4；13.6%（62/455）为P2/P3/P4闭塞。87/455（19.1%）例患者进行了 EVT。90 天后 mRS 0-1 的比例，替奈普酶组为 37.9%，阿替普酶组为 34.7%（调整风险比 [aRR] 1.07；95% 置信区间 [CI] 0.91-1.25）。两组患者的 90 天 mRS 0-2、sICH 和死亡率相似。在接受血管内血栓切除术的 87 名患者中，最初的再灌注成功率（13.0% 对 7.5%）没有统计学差异。然而，替奈普酶组的最终再灌注成功率更高（71.7% vs. 60.0%，aRR 1.29，95% CI 1.04-1.61）：结论：在MeVO患者中，静脉注射替奈普酶与静脉注射阿替普酶的安全性、功能预后和生活质量相当。在接受EVT治疗的患者中，替奈普酶的再灌注成功率高于阿替普酶。

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Tenecteplase Versus Alteplase in Medium Vessel Occlusion Ischemic Stroke: A Secondary Analysis of the Alteplase Compared to Tenecteplase Randomized Trial.

Background and purpose: The safety and efficacy of tenecteplase in patients with ischemic stroke due to medium vessel occlusion (MeVO) are not well studied. We aimed to compare tenecteplase with alteplase in stroke due to MeVO.

Methods: Patients with baseline M2-middle cerebral artery (MCA), M3/M4-MCA, P2/P3/P4-posterior cerebral artery (PCA), A2/A3/A4-anterior cerebral artery (ACA) occlusions from the Alteplase Compared to Tenecteplase (AcT) trial were included. Primary outcome was the proportion of 90-day modified Rankin Scale (mRS) 0-1. Secondary outcomes were 90-day mRS 0-2, ordinal mRS, mortality, quality of life measures (EuroQol 5-Dimension 5-Level, EuroQol visual analog scale), and symptomatic intracerebral hemorrhage (sICH). Initial and final successful reperfusion were reported in patients undergoing endovascular thrombectomy (EVT).

Results: Among 1,558 patients with available baseline computed tomography angiography; 455 (29.2%) had MeVO of which 27.5% (125/455) were proximal M2; 16.3% (74/455) were distal M2; 35.2% (160/455) were M3/M4; 7.5% (34/455) were A2/A3/A4; and 13.6% (62/455) were P2/P3/P4 occlusions. EVT was performed in 87/455 (19.1%) patients. mRS 0-1 at 90 days was achieved in 37.9% in the tenecteplase versus 34.7% in the alteplase group (adjusted risk ratio [aRR] 1.07; 95% confidence interval [CI] 0.91-1.25). Rates of 90-day mRS 0-2, sICH, and mortality were similar in both groups. No statistical difference was noted in initial successful reperfusion rates (13.0% vs. 7.5%) among the 87 patients who underwent endovascular thrombectomy. However, final successful reperfusion was higher in the tenecteplase group (71.7% vs. 60.0%, aRR 1.29, 95% CI 1.04-1.61).

Conclusion: Intravenous tenecteplase had comparable safety, functional outcomes and quality of life compared to intravenous alteplase among patients with MeVO. Among those treated with EVT, tenecteplase was associated with higher successful reperfusion rates than alteplase.

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来源期刊

Journal of Stroke CLINICAL NEUROLOGYPERIPHERAL VASCULAR DISE-PERIPHERAL VASCULAR DISEASE

CiteScore

11.00

自引率

3.70%

发文量

审稿时长

12 weeks

期刊介绍： The Journal of Stroke (JoS) is a peer-reviewed publication that focuses on clinical and basic investigation of cerebral circulation and associated diseases in stroke-related fields. Its aim is to enhance patient management, education, clinical or experimental research, and professionalism. The journal covers various areas of stroke research, including pathophysiology, risk factors, symptomatology, imaging, treatment, and rehabilitation. Basic science research is included when it provides clinically relevant information. The JoS is particularly interested in studies that highlight characteristics of stroke in the Asian population, as they are underrepresented in the literature. The JoS had an impact factor of 8.2 in 2022 and aims to provide high-quality research papers to readers while maintaining a strong reputation. It is published three times a year, on the last day of January, May, and September. The online version of the journal is considered the main version as it includes all available content. Supplementary issues are occasionally published. The journal is indexed in various databases, including SCI(E), Pubmed, PubMed Central, Scopus, KoreaMed, Komci, Synapse, Science Central, Google Scholar, and DOI/Crossref. It is also the official journal of the Korean Stroke Society since 1999, with the abbreviated title J Stroke.