Intravenous thrombolysis with teneplase for the treatment of acute ischemic stroke caused by medium vessel occlusion: comparison with atreplase
10.3760/cma.j.issn.1673-4165.2024.12.003
- VernacularTitle:替奈普酶静脉溶栓治疗中等血管闭塞所致急性缺血性卒中：与阿替普酶的比较
- Author:
Huijuan ZHANG
1
;
Xiaoyong ZHANG
;
Yuanfeng JIAO
;
He JIANG
Author Information
1. 东台市人民医院神经内科，东台 224200
- Keywords:
Ischemic stroke;
Arterial occlusive diseases;
Thrombolytic therapy;
Tenecteplase;
Tissue plasminogen activator;
Treatment outcome
- From:
International Journal of Cerebrovascular Diseases
2024;32(12):895-900
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the safety and efficacy of intravenous thrombolysis (IVT) with teneplase and alteplase in the treatment of acute ischemic stroke (AIS) caused by medium vessel occlusion (MeVO).Methods:Patients with AIS caused by MeVO received IVT treatment alone at Dongtai People's Hospital from January 2015 to June 2024 were included retrospectively. MeVO was defined as occlusion of the M2-M4 segment of the middle cerebral artery, A1-A3 segment of the anterior cerebral artery, or P1-P3 segment of the posterior cerebral artery. At 90 days after onset, the modified Rankin Scale was used to evaluate the clinical outcome. A score of ≤2 was defined as good outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors for clinical outcome. Results:A total of 185 patients with AIS caused by MeVO received IVT treatment alone were enrolled, including 114 males (61.6%), aged 65.0±12.0 years. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 3 (interquartile range, 2-5), and the median time from onset to needle was 90 (interquartile range, 51-162) minutes. Fifty-nine patients received teneplase treatment, and 126 received alteplase treatment; 133 patients (71.9%) had good outcome, and 52 (28.1%) had poor outcome. Univariate analysis showed that there was a significant difference in the site of vascular occlusion between the teneplase group and the alteplase group, and the proportion of patients with complete vessel recanalization and good outcome at 90 days was significantly higher than those of the alteplase group (all P<0.05). The baseline NIHSS score and the proportion of patients with any intracranial hemorrhage or symptomatic intracranial hemorrhage (sICH) in the good outcome group were significantly lower than those in the poor outcome group, while the proportion of patients who used teneplase, onset to needle time <3 hours, and complete/partial recanalization was significantly higher than those in the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that the higher baseline NIHSS score (odds ratio [ OR] 1.180, 95% confidence interval [ CI] 1.094-1.598; P<0.001), any intracranial hemorrhage ( OR 1.213, 95% CI 1.091-1.443; P=0.001) and sICH ( OR 1.292, 95% CI 1.078-1.931; P=0.012) were independently associated with the poor outcome, while the use of teneplase ( OR 0.607, 95% CI 0.543-0.784; P=0.021) and complete/partial recanalization ( OR 0.511, 95% CI 0.404-0.632; P<0.001) were independently associated with the good outcome. Conclusion:Compared with alteplase, the use of teneplase in the treatment of AIS induced by MeVO is associated with the better clinical outcome and does not increase the incidence of intracranial hemorrhage and sICH.
