부산대학교 도서관

Introduction:Recent evidence supports that IV tenecteplase (TNK) is non-inferior to IV alteplase when administered to eligible patients with acute ischemic stroke (AIS). Studies suggest that alteplase does not effectively lyse clots ≥ 8mm. However, the neurovascular characteristics of TNK are rapidly evolving. The aim of this study was to evaluate the efficacy of TNK in clot lysis ≥ 8mm as measured by hyperdense sign on CT for internal carotid artery (ICA) and middle cerebral artery (MCA M1 and M2 segment) occlusion.Methods:We conducted a retrospective cohort study of prospectively collected AIS patients who presented to our comprehensive stroke center, received TNK, and had hyperdense sign on CT head. Hyperdense signs were detected using 0.625 mm slices in retrospective fashion, blinded to the clinical scenario with regards to laterality. Revascularization was defined as modified Thrombolysis in Cerebral Infarction (mTICI) score on first run of digital subtraction angiography prior to intervention, follow up CTA or MRA without large vessel occlusion (LVO), and/or with improved clinical symptoms that correlate with hyperdense sign. Social science statistics software was used for data analysis.Results:From October 2020 to June 2022, out of 77 AIS patients who received TNK, 25 subjects (≥ 8mm, n=19) had associated hyperdense signs. Mean age was 67.16 (95% CI 60.05, 74.27). Median NIHSS was 14 (95% CI 11.378, 19.50). Mean thrombus length was 17.64 mm (95% CI, 13.26, 22.02). Twenty-one percent (n=4) of 19 subjects with hyperdense signs ≥ 8mm recanalized post-TNK (n=3 angiography, n=1 MRA). Thirty-three percent (n=2) of 6 subjects with hyperdense signs < 8mm recanalized post-TNK. There was not a statistically significant difference between recanalization rates in hyperdense signs ≥ 8mm or < 8mm (Fisher exact test statistic=0.61). There was not a statistically significant difference between intracerebral hemorrhage rates in hyperdense signs ≥ 8mm or < 8mm (Fisher exact test statistic=1).Conclusion:Our study suggests that tenecteplase may be associated with higher thrombolytic-related recanalization in thrombi measuring 8mm or greater as compared to historical alteplase experience. Larger, prospective studies are needed to corroborate our findings.