Please use this identifier to cite or link to this item: http://hdl.handle.net/1959.13/806500

OpenURL Link
Title
Acute ischemic stroke: imaging-guided tenecteplase treatment in an extended time window
Author/Creator
Parsons, M. W.;  Miteff, F.;  Bateman, G. A.;  Spratt, N.;  Loiselle, A.;  Attia, J.;  Levi, C. R.
Institution
The University of Newcastle. Faculty of Health, School of Medicine and Public Health
Description
Background: Tenecteplase is a modified tissue plasminogen activator with a longer half-life and higher fibrin specificity than alteplase. Methods: We conducted a prospective, nonrandomized, pilot study of 0.1 mg/kg IV tenecteplase given 3 to 6 hours after ischemic stroke onset. For a control group, we used patients contemporaneously treated with sub–3-hour 0.9 mg/kg IV alteplase following standard selection criteria. All patients underwent pretreatment and 24-hour perfusion/angiographic imaging with CT or MRI. Eligibility criteria for tenecteplase (but not alteplase) treatment included a perfusion lesion at least 20% greater than the infarct core, with an associated vessel occlusion. Primary outcomes, assessed blind to treatment group, were reperfusion (reduction in baseline–24-hour mean transit time lesion) and major vessel recanalization. Results: Fifteen patients received tenecteplase, and 35 patients received alteplase. The tenecteplase group had greater reperfusion (mean 74% vs 44% in the alteplase group, p = 0.01) and major vessel recanalization (10/15 tenecteplase vs 7/29 alteplase, p = 0.01). Despite later time to treatment, more tenecteplase patients (10/15 vs 7/35 alteplase, p = 0.001) had major neurologic improvement at 24 hours (NIH Stroke Scale reduction ≥8). Four of the alteplase patients and none of the tenecteplase patients had parenchymal hematoma at 24 hours. Conclusions: Tenecteplase 0.1 mg/kg, using advanced imaging guidance in an extended time window, may have significant biologic efficacy in acute ischemic stroke. The imaging selection differences between the tenecteplase and alteplase groups prevent a conclusive efficacy comparison. Nonetheless, these results lend support for randomized trials comparing tenecteplase with alteplase, preferably incorporating penumbral/angiographic imaging selection.
Relation
Neurology Vol. 72, Issue 10, p. 915-921
Publisher Link
http://dx.doi.org/10.1212/01.wnl.0000344168.05315.9d
Date
2009
Publisher
Lippincott Williams & Wilkins
Keyword(s)
tenecteplase;  tissue plasminogen activator;  alteplase;  ischemic stroke
Resource Type
journal article
Identifier
http://hdl.handle.net/1959.13/806500
Identifier
ISSN:0028-3878
Reviewed
Reviewed
78 Visitors 86 Hits 0 Downloads
Save/E-mail Citation
Citation Format
E-mail Address
Subject
"Neurology"
 
OR