The length of susceptibility vessel sign predicts early neurological deterioration in minor acute ischemic stroke with large vessel occlusion

He, Lanying; Wang, Jian; Wang, Feng; Zhang, Lili; Zhang, Lijuan; Zhao, Wang; Weng, Xiechuan; Xu, Fan

doi:10.1186/s12883-021-02455-7

Cited by 6 publications

(5 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…44 Further studies on this topic are needed, as a better efficacy of tenecteplase compared to alteplase in larger clots would be of particular importance as larger thrombi have been associated with early neurological deterioration and poor clinical outcomes. 45,46 Our study has several strengths. It is based on two large multicentric LVOS patient registries with similar practices.…”

Section: Discussionmentioning

confidence: 99%

Early recanalization among patients undergoing bridging therapy with tenecteplase or alteplase

Checkouri

Gerschenfeld

Seners

et al. 2023

Preprint

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Early recanalization among patients undergoing bridging therapy with tenecteplase or alteplase

Checkouri

Gerschenfeld

Seners

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…This conclusion was in line with the present study. Some scholars suggested that endovascular treatments may restore the blood ow thus lower the incidence of ND in patients with minor stroke with steno-occlusive arterial disease [25] .…”

Section: Discussionmentioning

confidence: 99%

The comparison of the risk of neurological deterioration and clinical outcomes in different atherosclerotic stroke patterns

He,

Zhang,

et al. 2024

Preprint

View full text Add to dashboard Cite

This study aims to compare the incidences of ND and poor outcome (a modified Ranking scale > 2 points at discharge) among patients with different atherosclerotic stroke patterns. A total of 688 participants were categorized into 4 groups according to atherosclerotic stroke pattern: multiple small infarcts (MSI), single subcortical infarction (SSI), borderzone infarct (BZI) and large infarct groups. Among the 4 groups, MSI group had the lowest incidences of ND and poor outcome (13.5% and 16.2%, respectively). In multivariable analyses, for BZI patients, the risks of ND [odds ratio (OR) = 4.33, 95% confidence interval (CI) = 2.37–7.94, p< 0.001] and poor outcome (OR = 4.16, 95% CI = 2.04–8.50, p < 0.001) both increased approximately 3-fold than MSI, both of which were the highest among the 4 stroke patterns. The neutrophil to lymphocyte ratio in BZI and large infarct groups were higher than in MSI and SSI groups [3.35 (2.28, 5.04) and 3.36 (2.53, 4.94) vs. 2.64 (1.89, 4.06) and 2.71 (1.93, 3.91), p< 0.001]. BZI group had the highest risks of ND and poor outcome among atherosclerotic stroke patients. BZI and large infarct patients had stronger poststroke inflammation than MSI and SSI patients.

show abstract

“…44 Further studies on this topic are needed, as a better efficacy of tenecteplase compared with alteplase in larger clots would be of particular importance, as larger thrombi have been associated with early neurological deterioration and poor clinical outcomes. 45,46…”

Section: Discussionmentioning

confidence: 99%

Early Recanalization Among Patients Undergoing Bridging Therapy With Tenecteplase or Alteplase

Checkouri,

Gerschenfeld,

Seners

et al. 2023

Stroke

View full text Add to dashboard Cite

BACKGROUND: Intravenous thrombolysis (IVT) with alteplase or tenecteplase before mechanical thrombectomy is the recommended treatment for large-vessel occlusion acute ischemic stroke. There are divergent data on whether these agents differ in terms of early recanalization (ER) rates before mechanical thrombectomy, and little data on their potential differences stratified by ER predictors such as IVT to ER evaluation (IVT-to-ER eval ) time, occlusion site and thrombus length. METHODS: We retrospectively compared the likelihood of ER after IVT with tenecteplase or alteplase in anterior circulation large-vessel occlusion acute ischemic stroke patients from the PREDICT-RECANAL (alteplase) and Tenecteplase Treatment in Ischemic Stroke (tenecteplase) French multicenter registries. ER was defined as a modified Thrombolysis in Cerebral Infartion score 2b-3 on the first angiographic run, or noninvasive vascular imaging in patients with early neurological improvement. Analyses were based on propensity score overlap weighting (leading to exact balance in patient history, stroke characteristics, and initial management between groups) and confirmed with adjusted logistic regression (sensitivity analysis). A stratified analysis based on pre-established ER predictors (IVT-to-ER eval time, occlusion site, and thrombus length) was conducted. RESULTS: Overall, 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, 0.83–1.44]; P =0.52). A differential effect of tenecteplase versus alteplase on the probability of ER according to thrombus length was observed ( P interaction =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 versus alteplase on the likelihood of ER according to the IVT-to-ER eval time ( P interaction =0.40) or occlusion site ( P interaction =0.80). CONCLUSIONS: Both thrombolytics achieved ER in one-fifth of patients with large-vessel occlusion acute ischemic stroke without significant interaction with IVT-to-ER eval time and occlusion site. Compared with alteplase, tenecteplase was associated with a 2-fold higher likelihood of ER in larger thrombi.

show abstract

The length of susceptibility vessel sign predicts early neurological deterioration in minor acute ischemic stroke with large vessel occlusion

Cited by 6 publications

References 31 publications

Early recanalization among patients undergoing bridging therapy with tenecteplase or alteplase

Early recanalization among patients undergoing bridging therapy with tenecteplase or alteplase

The comparison of the risk of neurological deterioration and clinical outcomes in different atherosclerotic stroke patterns

Early Recanalization Among Patients Undergoing Bridging Therapy With Tenecteplase or Alteplase

Contact Info

Product

Resources

About