Aristeidis H Katsanos1, Apostolos Safouris2,3, Amrou Sarraj4, Georgios Magoufis3, Ronen R Leker5, Pooja Khatri6, Charlotte Cordonnier7, Didier Leys7, Ashkan Shoamanesh1, Niaz Ahmed8,9, Andrei V Alexandrov10, Georgios Tsivgoulis2,10. 1. Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., A.S.). 2. Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, Greece (A. Safouris, G.T.). 3. Stroke Unit, Metropolitan Hospital, Piraeus, Greece (A. Safouris, G.M.). 4. Department of Neurology, UT Houston, TX (A. Sarraj). 5. Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (R.R.L.). 6. Department of Neurology, University of Cincinnati, OH (P.K.). 7. University of Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience and Cognition, France (C.C., D.L.). 8. Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A.). 9. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden (N.A.). 10. Department of Neurology, University of Tennessee Health Science Center, Memphis (A.V.A., G.T.).
Abstract
BACKGROUND AND PURPOSE: Accumulating evidence from randomized controlled clinical trials suggests that tenecteplase may represent an effective treatment alternative to alteplase for acute ischemic stroke. In the present systematic review and meta-analysis, we sought to compare the efficacy and safety outcomes of intravenous tenecteplase to intravenous alteplase administration for acute ischemic stroke patients with large vessel occlusions (LVOs). METHODS: We searched MEDLINE (Medical Literature Analysis and Retrieval System Online) and Scopus for published randomized controlled clinical trials providing outcomes of acute ischemic stroke with confirmed LVO receiving intravenous thrombolysis with either tenecteplase at different doses or alteplase at a standard dose of 0.9 mg/kg. The primary outcome was the odds of modified Rankin Scale score of 0 to 2 at 3 months. RESULTS: We included 4 randomized controlled clinical trials including a total of 433 patients. Patients with confirmed LVO receiving tenecteplase had higher odds of modified Rankin Scale scores of 0 to 2 (odds ratio, 2.06 [95% CI, 1.15-3.69]), successful recanalization (odds ratio, 3.05 [95% CI, 1.73-5.40]), and functional improvement defined as 1-point decrease across all modified Rankin Scale grades (common odds ratio, 1.84 [95% CI, 1.18-2.87]) at 3 months compared with patients with confirmed LVO receiving alteplase. There was little or no heterogeneity between the results provided from included studies regarding the aforementioned outcomes (I2≤20%). No difference in the outcomes of early neurological improvement, symptomatic intracranial hemorrhage, any intracranial hemorrhage, and the rates of modified Rankin Scale score 0 to 1 or all-cause mortality at 3 months was detected between patients with LVO receiving intravenous thrombolysis with either tenecteplase or alteplase. CONCLUSIONS: Acute ischemic stroke patients with LVO receiving intravenous thrombolysis with tenecteplase have significantly better recanalization and clinical outcomes compared with patients receiving intravenous alteplase.
BACKGROUND AND PURPOSE: Accumulating evidence from randomized controlled clinical trials suggests that tenecteplase may represent an effective treatment alternative to alteplase for acute ischemic stroke. In the present systematic review and meta-analysis, we sought to compare the efficacy and safety outcomes of intravenous tenecteplase to intravenous alteplase administration for acute ischemic strokepatients with large vessel occlusions (LVOs). METHODS: We searched MEDLINE (Medical Literature Analysis and Retrieval System Online) and Scopus for published randomized controlled clinical trials providing outcomes of acute ischemic stroke with confirmed LVO receiving intravenous thrombolysis with either tenecteplase at different doses or alteplase at a standard dose of 0.9 mg/kg. The primary outcome was the odds of modified Rankin Scale score of 0 to 2 at 3 months. RESULTS: We included 4 randomized controlled clinical trials including a total of 433 patients. Patients with confirmed LVO receiving tenecteplase had higher odds of modified Rankin Scale scores of 0 to 2 (odds ratio, 2.06 [95% CI, 1.15-3.69]), successful recanalization (odds ratio, 3.05 [95% CI, 1.73-5.40]), and functional improvement defined as 1-point decrease across all modified Rankin Scale grades (common odds ratio, 1.84 [95% CI, 1.18-2.87]) at 3 months compared with patients with confirmed LVO receiving alteplase. There was little or no heterogeneity between the results provided from included studies regarding the aforementioned outcomes (I2≤20%). No difference in the outcomes of early neurological improvement, symptomatic intracranial hemorrhage, any intracranial hemorrhage, and the rates of modified Rankin Scale score 0 to 1 or all-cause mortality at 3 months was detected between patients with LVO receiving intravenous thrombolysis with either tenecteplase or alteplase. CONCLUSIONS: Acute ischemic strokepatients with LVO receiving intravenous thrombolysis with tenecteplase have significantly better recanalization and clinical outcomes compared with patients receiving intravenous alteplase.
Authors: Amrou Sarraj; James Grotta; Gregory W Albers; Ameer E Hassan; Spiros Blackburn; Arthur Day; Clark Sitton; Michael Abraham; Chunyan Cai; Mark Dannenbaum; Deep Pujara; William Hicks; Ronald Budzik; Nirav Vora; Ashish Arora; Bader Alenzi; Wondwossen G Tekle; Haris Kamal; Osman Mir; Andrew D Barreto; Maarten Lansberg; Rishi Gupta; Sheryl Martin-Schild; Sean Savitz; Georgios Tsivgoulis Journal: Neurology Date: 2021-04-19 Impact factor: 11.800
Authors: Shuya Li; Bruce C V Campbell; Lee H Schwamm; Marc Fisher; Mark Parsons; Hao Li; Yuesong Pan; Yongjun Wang Journal: Stroke Vasc Neurol Date: 2021-08-26
Authors: Aristeidis H Katsanos; Klearchos Psychogios; Guillaume Turc; Simona Sacco; Diana Aguiar de Sousa; Gian Marco De Marchis; Lina Palaiodimou; Dimitrios K Filippou; Niaz Ahmed; Amrou Sarraj; Bijoy K Menon; Georgios Tsivgoulis Journal: JAMA Netw Open Date: 2022-03-01
Authors: Manon Kappelhof; Johanna Ospel; Nima Kashani; Petra Cimflova; Nishita Singh; Mohammed A Almekhlafi; Bijoy K Menon; Jens Fiehler; Michael Chen; Nobuyuki Sakai; Mayank Goyal Journal: J Neurointerv Surg Date: 2021-05-25 Impact factor: 8.572