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KMID : 1142120180200010122
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Journal of Stroke
2018 Volume.20 No. 1 p.122 ~ p.130
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Penumbral Imaging-Based Thrombolysis with Tenecteplase Is Feasible up to 24 Hours after Symptom Onset
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Kate Mahesh
Wannamaker Robert
Kamble Harsha
Riaz Parnian
Gioia Laura C.
Buck Brian
Jeerakathil Thomas
Smyth Penelope
Shuaib Ashfaq
Butcher Kenneth
Emery Derek
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Abstract
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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.
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KEYWORD
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Tenecteplase, Stroke
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