Penumbral Imaging-Based Thrombolysis with Tenecteplase Is Feasible up to 24 Hours after Symptom Onset
- Author:
Mahesh KATE
1
;
Robert WANNAMAKER
;
Harsha KAMBLE
;
Parnian RIAZ
;
Laura C GIOIA
;
Brian BUCK
;
Thomas JEERAKATHIL
;
Penelope SMYTH
;
Ashfaq SHUAIB
;
Kenneth BUTCHER
;
Derek EMERY
Author Information
- Publication Type:Original Article
- Keywords: Tenecteplase; Stroke
- MeSH: Alberta; Blood Volume; Diffusion; Hematoma; Hemorrhage; Humans; National Institutes of Health (U.S.); Perfusion; Prospective Studies; Stroke
- From:Journal of Stroke 2018;20(1):122-130
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND AND PURPOSE: Thrombolysis >4.5 hours after ischemic stroke onset is unproven. We assessed the feasibility of tenecteplase (TNK) treatment in patients with evidence of an ischemic penumbra 4.5 to 24 hours after onset. METHODS: Acute ischemic stroke patients underwent perfusion computed tomography (CT)/magnetic resonance imaging. Patients with cerebral blood volume (CBV) or diffusion weighted imaging Alberta Stroke Program Early CT Scores (ASPECTS) >6 and mismatch score >2 (defined as >2 ASPECTS regions with delay on mean transit time maps and normal CBV) were eligible for treatment with TNK (0.25 mg/kg). Patients with mismatch patterns enrolled in non-endovascular/non-thrombolysis trials and those without mismatch patterns served as comparators. RESULTS: The median (interquartile range) baseline National Institutes of Health Stroke Scale (NIHSS) in TNK treated patients (n=16) was 12 (range, 8 to 15). In the untreated mismatch (n=18) and nonmismatch (n=23) groups, the baseline NIHSS was 12 (range, 7 to 12) and 16 (range, 8 to 20; P=0.09) respectively. There was one symptomatic hemorrhage each in the TNK group (parenchymal hematoma [PH] 2) and non-mismatch group (PH 2). Penumbral salvage volumes were higher in TNK treated patients (48.3 mL [range, 24.9 to 80.4]) than the non-mismatch (–90.8 mL [range, –197 to –20]; P < 0.0001) patients. CONCLUSIONS: This prospective, non-randomized study supports the feasibility of TNK therapy in patients with evidence of ischemic penumbra 4 to 24 hours after onset.
