Safety and Efficacy of Tenecteplase and Alteplase in Patients With Tandem Lesion Stroke

 So no reporting or measurement of 100% recovery, obviously not important to the medical staff or researchers. But vastly important to stroke survivors. 

“What's measured, improves.” So said management legend and author Peter F. Drucker 

The latest bad research here;

Safety and Efficacy of Tenecteplase and Alteplase in Patients With Tandem Lesion Stroke

A Post Hoc Analysis of the EXTEND-IA TNK Trials

View ORCID ProfileVignan Yogendrakumar, Leonid Churilov, Peter J. Mitchell, Timothy J. Kleinig, View ORCID ProfileNawaf Yassi, View ORCID ProfileVincent Thijs, Teddy Wu, Darshan Shah, Peter Bailey, View ORCID ProfileHelen M. Dewey, Philip M.C. Choi, Alice Ma, View ORCID ProfileTissa Wijeratne, View ORCID ProfileCarlos Garcia-Esperon, View ORCID ProfileGeoffrey Cloud, Ronil V. Chandra, Dennis J. Cordato, Bernard Yan, Gagan Sharma, Patricia M. Desmond, Mark W. Parsons, Geoffrey A. Donnan, Stephen M. Davis, View ORCID ProfileBruce C.V. Campbell, for the EXTEND-IA TNK Investigators

First published March 6, 2023, DOI: https://doi.org/10.1212/WNL.0000000000207138

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Abstract

Background and Objectives The safety and efficacy of tenecteplase (TNK) in patients with tandem lesion (TL) stroke is unknown. We performed a comparative analysis of TNK and alteplase in patients with TLs.

Methods We first compared the treatment effect of TNK and alteplase in patients with TLs using individual patient data from the EXTEND-IA TNK trials. We evaluated intracranial reperfusion at initial angiographic assessment and 90-day modified Rankin scale (mRS) with ordinal logistic and Firth regression models. Because 2 key outcomes, mortality and symptomatic intracranial hemorrhage (sICH), were few in number among those who received alteplase in the EXTEND-IA TNK trials, we generated pooled estimates for these outcomes by supplementing trial data with estimates of incidence obtained through a meta-analysis of studies identified in a systematic review. We then calculated unadjusted risk differences to compare the pooled estimates for those receiving alteplase with the incidence observed in the trial among those receiving TNK.

Results Seventy-one of 483 patients (15%) in the EXTEND-IA TNK trials possessed a TL. In patients with TLs, intracranial reperfusion was observed in 11/56 (20%) of TNK-treated patients vs 1/15 (7%) alteplase-treated patients (adjusted odds ratio 2.19; 95% CI 0.28–17.29). No significant difference in 90-day mRS was observed (adjusted common odds ratio 1.48; 95% CI 0.44–5.00). A pooled study-level proportion of alteplase-associated mortality and sICH was 0.14 (95% CI 0.08–0.21) and 0.09 (95% CI 0.04–0.16), respectively. Compared with a mortality rate of 0.09 (95% CI 0.03–0.20) and an sICH rate of 0.07 (95% CI 0.02–0.17) in TNK-treated patients, no significant difference was observed.

Discussion Functional outcomes, mortality, and sICH did not significantly differ between patients with TLs treated with TNK and those treated with alteplase.

Classification of Evidence This study provides Class III evidence that TNK is associated with similar rates of intracranial reperfusion, functional outcome, mortality, and sICH compared with alteplase in patients with acute stroke due to TLs. However, the CIs do not rule out clinically important differences.

Trial Registration Information clinicaltrials.gov/ct2/show/NCT02388061; clinicaltrials.gov/ct2/show/NCT03340493.