Recanalization before Thrombectomy in Tenecteplase vs. Alteplase-Treated Drip-and-Ship Patients

Abstract

The Extending the time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial using Tenecteplase (EXTEND-IA TNK) trial recently showed 2-fold higher early recanalization (ER) rate before mechanical thrombectomy (MT) following intravenous thrombolysis (IVT) with tenecteplase 0.25 mg/kg, as compared to alteplase 0.9 mg/kg. 1 However, most included patients were directly admitted to MT-capable centres ('mothership' paradigm), implying short IVT-to-MT delays. Tenecteplase may therefore be preferred in the mothership setting. Here, we assessed ER rate before MT following tenecteplase or alteplase in patients transferred for MT from a non-MT-capable centre ('drip-and-ship' paradigm), i.e., implying longer IVT-to-MT delays, currently the most frequent situation. nclusion criteria for the present retrospective study were (1) acute stroke with large vessel occlusion treated with IVT with tenecteplase 0.25 mg/kg or alteplase 0.9 mg/kg; and (2) ER evaluation 3 hours from IVT start on pre-MT first angiographic run or non-invasive vascular imaging. Tenecteplase patients were all from one large French non-MT-capable centre, which based on previous trials Alteplase patients were from 23 other French non-MT-capable centres. ER