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Functional Outcome, Recanalization, and Hemorrhage Rates After Large Vessel Occlusion Stroke Treated With Tenecteplase Before Thrombectomy

Gaspard Gerschenfeld 1, 2 Didier Smadja 3 Guillaume Turc 4, 5, 6 Stephane Olindo 7 François-Xavier Laborne 8 Marion Yger 3 Jildaz Caroff 9 Bruno Gonçalves 10, 4, 5, 6 Pierre Seners 10, 4, 5, 6 Marie Cantier 1 Yann l'Hermitte 3 Manvel Aghasaryan 3 Cosmin Alecu 3 Gaultier Marnat 11 Wagih Ben Hassen 4, 5, 6 Erwah Kalsoum 12 Frédéric Clarençon 13 Michel Piotin 14 Laurent Spelle 9 Christian Denier 9 Igor Sibon 11 Sonia Alamowitch 1 Nicolas Chausson 3, *
* Corresponding author
1 Service de Neurologie [CHU Saint-Antoine]
2 SU FM - Sorbonne Université - Faculté de Médecine
3 Service de Neurologie et Unité Neurovasculaire [Centre Hospitalier Sud-Francilien]
4 IPNP - U1266 Inserm - Institut de psychiatrie et neurosciences de Paris
5 GHU Paris Psychiatrie et Neurosciences
6 GHU-PPN - FHU NeuroVasc [Site Sainte-Anne, Paris]
7 Service de neurologie [Bordeaux]
8 Centre Hospitalier Sud Francilien
9 AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)
10 Service de Neurologie, GHU Paris Psychiatrie et Neurosciences, Université de Paris, INSERM U1266, FHU Neurovasc, Paris, France
11 CHU Bordeaux [Bordeaux]
12 CHU Henri Mondor
13 CHU Pitié-Salpêtrière [AP-HP]
14 Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
Abstract : Objective: To investigate in routine care the efficacy and safety of IV thrombolysis (IVT) with tenecteplase prior to mechanical thrombectomy (MT) in patients with large vessel occlusion acute ischemic strokes (LVO-AIS), either secondarily transferred after IVT or directly admitted to a comprehensive stroke center (CSC). Methods: We retrospectively analyzed clinical and procedural data of patients treated with 0.25 mg/kg tenecteplase within 270 minutes of LVO-AIS who underwent a brain angiography. The main outcome was 3-month functional independence (modified Rankin scale score ≤ 2). Recanalization (revised Treatment in Cerebral Ischemia score 2b-3), was evaluated before (pre-MT) and after MT (final). Results: We included 588 patients (median age 75 years [interquartile range (IQR) 61-84]; 315 women [54%]; median NIH Stroke Scale [NIHSS] score 16 [IQR 10-20]), of which 520 (88%) were secondarily transferred after IVT. Functional independence occurred in 47% (n = 269/570; 95%CI 43.0-51.4) of patients. Pre-MT recanalization occurred in 120 patients (20.4%; 95%CI 17.2-23.9), at a similar rate across treatment paradigms (direct admission, n = 14/68 [20.6%]; secondary transfer, n = 106/520 [20.4%]; p > .99) despite a shorter median IVT-to-puncture time in directly admitted patients (38 [IQR 23-55] vs 86 [IQR 70-110] minutes; p < .001). Final recanalization was achieved in 492 patients (83.7%; 95%CI 80.4-86.6). Symptomatic intracerebral hemorrhage occurred in 2.5% of patients (n = 14/567; 95%CI 1.4-4.1). Conclusions: Tenecteplase before MT is safe, effective and achieves a fast recanalization in everyday practice in patients secondarily transferred or directly admitted to a CSC, in line with published results. These findings should encourage its wider use in bridging therapy. Classification of evidence: This study provides class IV evidence that tenecteplase within 270 minutes of LVO-AIS is increases the probability of functional independence.
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https://www.hal.inserm.fr/inserm-03379553
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Submitted on : Friday, October 15, 2021 - 8:56:43 AM
Last modification on : Wednesday, December 8, 2021 - 3:44:48 AM

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INSERM | UP-SANTE | UNIV-PARIS | SORBONNE-UNIVERSITE | SU-MEDECINE | SU-TI

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Gaspard Gerschenfeld, Didier Smadja, Guillaume Turc, Stephane Olindo, François-Xavier Laborne, et al.. Functional Outcome, Recanalization, and Hemorrhage Rates After Large Vessel Occlusion Stroke Treated With Tenecteplase Before Thrombectomy. Neurology, American Academy of Neurology, 2021, pp.10.1212/WNL.0000000000012915. ⟨10.1212/WNL.0000000000012915⟩. ⟨inserm-03379553⟩

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