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Title: Tenecteplase versus alteplase before endovascular thrombectomy (EXTEND-IA TNK): A multicenter, randomized, controlled study.
Austin Authors: Campbell, Bruce Cv;Mitchell, Peter J;Churilov, Leonid ;Yassi, Nawaf;Kleinig, Timothy J;Yan, Bernard;Dowling, Richard J;Bush, Steven J;Dewey, Helen M;Thijs, Vincent N ;Simpson, Marion A ;Brooks, Duncan Mark ;Asadi, Hamed ;Wu, Teddy Y;Shah, Darshan G;Wijeratne, Tissa;Ang, Timothy;Miteff, Ferdinand;Levi, Christopher;Krause, Martin;Harrington, Timothy J;Faulder, Kenneth C;Steinfort, Brendan S;Bailey, Peter;Rice, Henry;de Villiers, Laetitia;Scroop, Rebecca;Collecutt, Wayne;Wong, Andrew A;Coulthard, Alan;Barber, P A;McGuinness, Ben;Field, Deborah;Ma, Henry;Chong, Winston;Chandra, Ronil V;Bladin, Christopher F;Brown, Helen;Redmond, Kendal;Leggett, David;Cloud, Geoffrey;Madan, Anoop;Mahant, Neil;O'Brien, Bill;Worthington, John;Parker, Geoffrey;Desmond, Patricia M;Parsons, Mark W;Donnan, Geoffrey A ;Davis, Stephen M
Affiliation: Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital , University of Melbourne , Parkville, Victoria, Australia
Department of Radiology, the Royal Melbourne Hospital , University of Melbourne , Parkville, Victoria, Australia
Florey Institute of Neuroscience and Mental Health , University of Melbourne , Parkville, Australia
Royal Adelaide Hospital , Adelaide, South Australia, Australia
Department of Neurosciences, Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Victoria, Australia
Gosford Hospital , Gosford, New South Wales, Australia
Austin Health, Heidelberg, Victoria, Australia
School of Medicine, Faculty of Health, Deakin University, Victoria, Australia
Christchurch Hospital, Christchurch, New Zealand
Princess Alexandra Hospital , Brisbane, Queensland, Australia
Department of Medicine and Neurology, Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans Victoria, Australia
Department of Neurology, Priority Research Centre for Brain and Mental Health Research, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
Royal Prince Alfred Hospital , Camperdown, New South Wales, Australia
Royal North Shore Hospital, St Leonards, New South Wales, Australia
Westmead Hospital, Sydney, New South Wales, Australia
Gold Coast University Hospital , Southport, Queensland, Australia
Royal Brisbane & Women's Hospital, University of Queensland, Brisbane, Queensland, Australia
Auckland Hospital, University of Auckland, Auckland, New Zealand
Lyell McEwin Hospital , Adelaide, South Australia, Australia
Monash Medical Centre, Monash University, Clayton, Victoria, Australia
Alfred Hospital , Monash University, Prahran Victoria, Australia
Issue Date: Apr-2018
Date: 2017-09-27
Publication information: International Journal of Stroke 2018; 13(3): 328-334
Abstract: Background and hypothesis Intravenous thrombolysis with alteplase remains standard care prior to thrombectomy for eligible patients within 4.5 h of ischemic stroke onset. However, alteplase only succeeds in reperfusing large vessel arterial occlusion prior to thrombectomy in a minority of patients. We hypothesized that tenecteplase is non-inferior to alteplase in achieving reperfusion at initial angiogram, when administered within 4.5 h of ischemic stroke onset, in patients planned to undergo endovascular therapy. Study design EXTEND-IA TNK is an investigator-initiated, phase II, multicenter, prospective, randomized, open-label, blinded-endpoint non-inferiority study. Eligibility requires a diagnosis of ischemic stroke within 4.5 h of stroke onset, pre-stroke modified Rankin Scale≤3 (no upper age limit), large vessel occlusion (internal carotid, basilar, or middle cerebral artery) on multimodal computed tomography and absence of contraindications to intravenous thrombolysis. Patients are randomized to either IV alteplase (0.9 mg/kg, max 90 mg) or tenecteplase (0.25 mg/kg, max 25 mg) prior to thrombectomy. Study outcomes The primary outcome measure is reperfusion on the initial catheter angiogram, assessed as modified treatment in cerebral infarction 2 b/3 or the absence of retrievable thrombus. Secondary outcomes include modified Rankin Scale at day 90 and favorable clinical response (reduction in National Institutes of Health Stroke Scale by ≥8 points or reaching 0-1) at day 3. Safety outcomes are death and symptomatic intracerebral hemorrhage. Trial registration NCT02388061.
DOI: 10.1177/1747493017733935
ORCID: 0000-0003-3632-9433
Journal: International Journal of Stroke
PubMed URL: 28952914
Type: Journal Article
Subjects: CT perfusion
Ischaemic Stroke
endovascular thrombectomy
intra-arterial clot retrieval
randomized trial
tissue plasminogen activator
Appears in Collections:Journal articles

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