Evidence map›Paper›PMID 37731173›Full record

Trial reportInternational journal of stroke : official journal of the International Stroke Society2024

Safety and efficacy of tenecteplase versus alteplase in stroke patients with carotid tandem lesions: Results from the AcT trial.

Fouzi Bala, Mohammed Almekhlafi, Nishita Singh, Ibrahim Alhabli, Ayoola Ademola, Shelagh B Coutts, Yan Deschaintre, Houman Khosravani, Ramana Appireddy, Francois Moreau and 25 more

Open access · hybridAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in International journal of stroke : official journal of the International Stroke Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 4 pooled it
2.8field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 4 syntheses or guidelines pooled it, 13 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Management of tandem occlusions in acute ischaemic stroke.Therapeutic advances in neurological disorders · 2026
    Review
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

35 authors at 20 institutions in 2 countries.

Fouzi BalaDepartment of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.ORCID 0000-0001-6748-2081
Mohammed AlmekhlafiDepartment of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
Nishita SinghDepartment of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.ORCID 0000-0003-3647-0904
Ibrahim AlhabliDepartment of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
Ayoola AdemolaDepartment of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.ORCID 0000-0002-8412-6246
Shelagh B CouttsDepartment of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.ORCID 0000-0001-5090-5105
Yan DeschaintreCentre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
Houman KhosravaniSunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Ramana AppireddyDivision of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada.
Francois MoreauUniversité de Sherbrooke, Sherbrooke, QC, Canada.
Stephen PhillipsQueen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.
Gord GubitzQueen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.
Aleksander TkachKelowna General Hospital, Kelowna, BC, Canada.
Luciana CataneseHamilton Health Sciences, McMaster University, Hamilton, ON, Canada.ORCID 0000-0002-8696-5211
Dar DowlatshahiDepartment of Medicine, University of Ottawa, Ottawa, ON, Canada.ORCID 0000-0003-1379-3612
George MedvedevThe University of British Columbia, Vancouver, BC, Canada.
Jennifer MandziaLondon Health Sciences Centre, Western University, London, ON, Canada.
Aleksandra PikulaToronto Western Hospital, University of Toronto, Toronto, ON, Canada.
Jay ShankarUniversity of Manitoba, Winnipeg, MB, Canada.ORCID 0000-0002-3707-9723
Heather WilliamsQueen Elizabeth Hospital, Charlottetown, PEI, Canada.
Thalia S FieldVancouver Stroke Program, Division of Neurology, The University of British Columbia, Vancouver, BC, Canada.ORCID 0000-0002-1176-0633
Alejandro ManosalvaMedicine Hat Regional Hospital, Medicine Hat, AB, Canada.ORCID 0000-0001-8801-9248
Muzaffar SiddiquiGrey Nuns Community Hospital, Edmonton, AB, Canada.
Atif ZafarSt. Michael's Hospital, Toronto, ON, Canada.
Oje ImoukhoudeRed Deer Regional Hospital Centre, Red Deer, AB, Canada.
Gary HunterUniversity of Saskatchewan, Saskatoon, SK, Canada.
Faysal BenaliDepartment of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
MacKenzie HornDepartment of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
Michael D HillDepartment of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.ORCID 0000-0002-6269-1543
Michel ShamyDepartment of Medicine, University of Ottawa, Ottawa, ON, Canada.ORCID 0000-0002-0085-6816
Tolulope T SajobiDepartment of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
Brian H BuckDivision of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Richard H SwartzSunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.ORCID 0000-0001-6571-5531
Bijoy K MenonDepartment of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
Alexandre Y PoppeCentre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.ORCID 0000-0002-1419-2635
University of Calgary · CACentre Hospitalier de l’Université de Montréal · CAQueen Elizabeth II Health Sciences Centre · CASunnybrook Health Science Centre · CAUniversity of British Columbia · CAUniversity of Ottawa · CAGrey Nuns Community Hospital · CAHamilton Health Sciences · CAKelowna General Hospital · CAMedicine Hat Regional Hospital · CAQueen's University · CARed Deer Regional Hospital · CASt. Michael's Hospital · CAUniversité de Sherbrooke · CAUniversité de Tours · FRUniversity of Alberta · CAUniversity of Manitoba · CAUniversity of Saskatchewan · CAUniversity of Toronto · CAWestern University · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCarotid tandem lesions ((TL) ⩾70% stenosis or occlusion) account for 15-20% of acute stroke with large vessel occlusion.

aimsWe investigated the safety and efficacy of intravenous tenecteplase (0.25 mg/kg) versus intravenous alteplase (0.9 mg/kg) in patients with carotid TL.

methodsThis is a substudy of the alteplase compared with the tenecteplase trial. Patients with ⩾70% stenosis of the extracranial internal carotid artery (ICA) and concomitant occlusion of the intracranial ICA, M1 or M2 segments of the middle cerebral artery on baseline computed tomography angiography (CTA) were included. Primary outcome was 90-day-modified Rankin Scale (mRS) 0-1. Secondary outcomes were mRS 0-2, mortality, and symptomatic ICH (sICH). Angiographic outcomes were successful recanalization (revised Arterial Occlusive Lesion (rAOL) 2b-3) on first and successful reperfusion (eTICI 2b-3) on final angiographic acquisitions. Multivariable mixed-effects logistic regression was performed.

resultsAmong 1577 alteplase versus tenecteplase randomized controlled trial (AcT) patients, 128 (18.8%) had carotid TL. Of these, 93 (72.7%) underwent intravenous thrombolysis plus endovascular thrombectomy (IVT + EVT), while 35 (27.3%) were treated with IVT alone. In the IVT + EVT group, tenecteplase was associated with higher odds of 90-day-mRS 0-1 (46.0% vs. 32.6%, adjusted OR (aOR) 3.21; 95% CI = 1.06-9.71) compared with alteplase. No statistically significant differences in rates of mRS 0-2 (aOR 1.53; 95% CI = 0.51-4.55), initial rAOL 2b-3 (16.3% vs. 28.6%), final eTICI 2b-3 (83.7% vs. 85.7%), and mortality (18.0% vs. 16.3%) were found. SICH only occurred in one patient. There were no differences in outcomes between thrombolytic agents in the IVT-only group.

conclusionIn patients with carotid TL treated with EVT, intravenous tenecteplase may be associated with similar or better clinical outcomes, similar angiographic reperfusion rates, and safety outcomes as compared with alteplase.

Indexed as

Arterial Occlusive DiseasesBrain IschemiaEndovascular ProceduresStrokeConstriction, PathologicFibrinolytic AgentsHumansTenecteplaseThrombectomyTissue Plasminogen ActivatorTreatment OutcomeFibrinolytic AgentsTenecteplaseTissue Plasminogen ActivatorendovascularStroketandemtenecteplase

Identifiers

PMID37731173
PMCPMC10903116
OpenAlexW4386910925

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.