Evidence map›Paper›PMID 38960948›Full record

ArticleJournal of neurology2024

Tenecteplase versus alteplase before stroke thrombectomy: outcomes after system-wide transitions in Pennsylvania.

Philipp Hendrix, Bradley A Gross, Sepideh Allahdadian, Georgios S Sioutas, Prateeka Koul, Antonio Corral Tarbay, Michael J Lang, Visish M Srinivasan, Alhamza R Al-Bayati, Jiang Li and 5 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
–field-weighted citation impact
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

8 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Thrombolytic agents, more options, more challenges.Stroke and vascular neurology · 2026
    Article
  5. Article
  6. Review
  7. Article
  8. 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

15 authors.

Philipp HendrixDepartment of Neurosurgery, Geisinger, Danville, PA, USA. Hendrix.philipp@gmail.com.ORCID http://orcid.org/0000-0003-0017-5049
Bradley A GrossDepartment of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Sepideh AllahdadianDepartment of Neurology, Penn State Neuroscience Institute, Hershey, PA, USA.
Georgios S SioutasDepartment of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Prateeka KoulDepartment of Neurosurgery, Geisinger, Danville, PA, USA.
Antonio Corral TarbayDepartment of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Michael J LangDepartment of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Visish M SrinivasanDepartment of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Alhamza R Al-BayatiDepartment of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Jiang LiDepartment of Molecular and Functional Genomics, Weis Center for Research, Geisinger, Danville, PA, USA.
Anthony NotoDepartment of Neurology, Geisinger, Danville, PA, USA.
Raul G NogueiraDepartment of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Jan-Karl BurkhardtDepartment of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Ramin ZandDepartment of Neurology, Penn State Neuroscience Institute, Hershey, PA, USA.
Clemens M SchirmerDepartment of Neurosurgery, Geisinger, Danville, PA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionUnited States stroke systems are increasingly transitioning from alteplase (TPA) to tenecteplase (TNK). Real-world data on the safety and effectiveness of replacing TPA with TNK before large vessel occlusion (LVO) stroke endovascular treatment (EVT) are lacking.

methodsFour Pennsylvania stroke systems transitioned from TPA to TNK during the study period 01/2020-06/2023. LVO stroke patients who received intravenous thrombolysis with TPA or TNK before EVT were reviewed. Multivariate logistic analysis was conducted adjusting for age, sex, National Institute of Health Stroke Scale (NIHSS), occlusion site, last-known-well-to-intravenous thrombolysis time, interhospital-transfer and stroke system.

resultsOf 635 patients, 309 (48.7%) received TNK and 326 (51.3%) TPA prior to EVT. The site of occlusion was the M1 middle cerebral artery (MCA) (47.7%), M2 MCA (25.4%), internal carotid artery (14.0%), tandem carotid with M1 or M2 MCA (9.8%) and basilar artery (3.1%). A favorable functional outcome (90-day mRS ≤ 2) was observed in 47.6% of TNK and 49.7% of TPA patients (p = 0.132). TNK versus TPA groups had similar rates of early recanalization (11.9% vs. 8.4%, p = 0.259), successful endovascular reperfusion (93.5% vs. 89.3%, p = 0.627), symptomatic intracranial hemorrhage (3.2% vs. 3.4%, p = 0.218) and 90-day all-cause mortality (23.1% vs. 21.5%, p = 0.491).

conclusionsThis U.S. multicenter real-world clinical experience demonstrated that switching from TPA to TNK before EVT for LVO stroke resulted in similar endovascular reperfusion, safety, and functional outcomes.

Indexed as

Fibrinolytic AgentsIschemic StrokeTenecteplaseThrombectomyTissue Plasminogen ActivatorAgedAged, 80 and overEndovascular ProceduresFemaleHumansMaleMiddle AgedPennsylvaniaStrokeThrombolytic TherapyTreatment OutcomeFibrinolytic AgentsTenecteplaseTissue Plasminogen ActivatorIschemic strokeReperfusionTenecteplaseThrombectomyTissue-type plasminogen activator

Identifiers

PMID38960948
PMCPMC11319427

What Socratic holds

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LicenceCC BY
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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.