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  • Tenecteplase versus alteplase before endovascular thrombectomy (EXTEND-IA TNK): A multicenter, randomized, controlled study

    Author(s)
    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
    Simpson, Marion
    Brooks, 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
    et al.
    Griffith University Author(s)
    Bailey, Peter A.
    Year published
    2018
    Metadata
    Show full item record
    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, ...
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    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.
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    Journal Title
    International Journal of Stroke
    Volume
    13
    Issue
    3
    DOI
    https://doi.org/10.1177/1747493017733935
    Subject
    Clinical Sciences
    Neurosciences
    Publication URI
    http://hdl.handle.net/10072/382854
    Collection
    • Journal articles

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