Early recanalization among patients undergoing bridging therapy with tenecteplase or alteplase

Abstract

Background: <break><break>Intravenous thrombolysis (IVT) with alteplase or tenecteplase prior to mechanical thrombectomy (MT) is the recommended treatment for large-vessel occlusion acute ischemic stroke (LVOS). There are divergent data on whether these agents differ in terms of early recanalization (ER) rates before MT, and little data on their potential differences in terms of established ER predictors such as time elapsed between IVT and ER evaluation (IVT-to-ERevaltime), occlusion site and thrombus length.<break><break>Methods: <break><break>We compared the likelihood of ER after IVT with tenecteplase or alteplase in anterior circulation LVOS patients from the PREDICT-RECANAL (alteplase) and TETRIS (tenecteplase) French multicenter registries. ER was defined as a modified thrombolysis in cerebral infarction score 2b-3 on first angiographic run or noninvasive vascular imaging (magnetic resonance or computed tomography angiography) in patients with early neurological improvement. Analyses were based on propensity score overlap weighting (PSOW, leading to an exact balance in baseline characteristics between the treatment groups) and confirmed with adjusted logistic regression (sensitivity analysis).<break><break>Results: <break><break>A total of 1865 patients were included. ER occurred in 156/787 (19.8%) and 199/1078 (18.5%) patients treated with tenecteplase or alteplase, respectively (odds ratio, 1.09 [95%CI 0.831.44];P=0.52). A differential effect of tenecteplase vs alteplase on the probability of ER according to thrombus length was observed (Pinteraction=0.003), with tenecteplase being associated with higher odds of ER in thrombi > 10 mm (odds ratio, 2.43 [95% CI 1.02-5.81];P=0.04). There was no differential effect of tenecteplase vs alteplase on the likelihood of ER according to the IVT-to-ERevaltime (Pinteraction=0.40) or occlusion site (Pinteraction=0.80).<break><break>Conclusion: <break><break>Both thrombolytics achieved ER in a fifth of LVOS patients, with potentially greater effect of tenecteplase in larger thrombi. There was no significant differential influence of IVT-to-EReval time or occlusion site on likelihood of ER.