title: Intra-arterial tenecteplase for treatment of acute ischemic stroke: feasibility and comparative outcomes.
abstract: OBJECTIVE
  Tenecteplase (TNK) is a third-generation thrombolytic agent. We evaluated the safety and feasibility of intra-arterial (IA) administration of TNK in patients with acute ischemic stroke.
  
  
  METHODS
  Patients who received endovascular treatment for acute ischemic stroke were identified from prospectively collected databases at three university hospitals. We compared clinical and radiological outcomes of patients treated with TNK to those treated with other IA thrombolytics or mechanical thrombectomy alone. Primary outcome measures were favorable functional outcome at 30 days (modified Rankin Scale score of 0-2), and rate of intracranial hemorrhage (ICH). Early neurological improvement, angiographic recanalization, time to recanalization, and mortality at 30 days were additional outcome measures.
  
  
  RESULTS
  We identified 114 patients (mean age 67 ± 15 years, 54 were women). Thirty-three patients received IA TNK, 48 received alteplase (n = 11) or reteplase (n = 37), and 33 patients had mechanical thrombectomy alone. Stroke severity was similar among the three groups. No difference between the groups was found in the secondary outcome measures and ICH. Borderline statistical significance was seen toward favorable functional outcome at 1 month in the TNK-treated patients [odds ratio (OR) = 2.8; 95% confidence interval (CI) .96-8.1, P = .063 vs. other thrombolytics, and OR = 3.0, 95% CI .97-9.5, P = .06 vs. mechanical thrombectomy alone].
  
  
  CONCLUSIONS
  Our study demonstrates that administration of IA TNK in acute stroke is safe and results in rates of favorable outcomes that are comparable to those observed with currently used drugs. Additional studies are needed to further determine the safety and efficacy of IA TNK in acute stroke treatment.
authors: Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA. alg1971@gmail.com
authors: Alexandros L
authors: AL
authors: Georgiadis
authors: Muhammad Zeeshan
authors: MZ
authors: Memon
authors: Qaisar A
authors: QA
authors: Shah
authors: Gabriela
authors: G
authors: Vazquez
authors: Nauman A
authors: NA
authors: Tariq
authors: M Fareed K
authors: MF
authors: Suri
authors: Robert A
authors: RA
authors: Taylor
authors: Adnan I
authors: AI
authors: Qureshi
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy* / Q000453:epidemiology*; D015897:Comorbidity; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology*; D000077785:Tenecteplase; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase