{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T12:33:27Z","timestamp":1789475607192,"version":"build-2803163510"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>United 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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Four Pennsylvania stroke systems transitioned from TPA to TNK during the study period 01\/2020\u201306\/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.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 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\u2009\u2264\u20092) was observed in 47.6% of TNK and 49.7% of TPA patients (<jats:italic>p<\/jats:italic>\u2009=\u20090.132). TNK versus TPA groups had similar rates of early recanalization (11.9% vs. 8.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.259), successful endovascular reperfusion (93.5% vs. 89.3%, <jats:italic>p<\/jats:italic>\u2009=\u20090.627), symptomatic intracranial hemorrhage (3.2% vs. 3.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.218) and 90-day all-cause mortality (23.1% vs. 21.5%, <jats:italic>p<\/jats:italic>\u2009=\u20090.491).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This 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.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00415-024-12530-x","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T16:05:46Z","timestamp":1720022746000},"page":"5637-5641","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Tenecteplase versus alteplase before stroke thrombectomy: outcomes after system-wide transitions in Pennsylvania"],"prefix":"10.1007","volume":"271","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0017-5049","authenticated-orcid":false,"given":"Philipp","family":"Hendrix","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley A.","family":"Gross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sepideh","family":"Allahdadian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios S.","family":"Sioutas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prateeka","family":"Koul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Corral","family":"Tarbay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Lang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Visish M.","family":"Srinivasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alhamza R.","family":"Al-Bayati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Noto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul G.","family":"Nogueira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan-Karl","family":"Burkhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramin","family":"Zand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens M.","family":"Schirmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,3]]},"reference":[{"key":"12530_CR1","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1016\/S0140-6736(22)02600-9","volume":"401","author":"Y Wang","year":"2023","unstructured":"Wang Y, Li S, Pan Y et al (2023) Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial. 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ARA is consultant for Cerenovus and Stryker Neurovascular. RGN reports consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Philips, Hybernia, Hyperfine, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, Synchron, and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, CrestecBio Inc., Euphrates Vascular, Inc., Vesalio, Viz-AI, RapidPulse and Perfuze. RGN is one of the Principal Investigators of the \u201cEndovascular Therapy for Low NIHSS Ischemic Strokes (ENDOLOW)\u201d trial. Funding for this project is provided by Cerenovus. RGN is the Principal Investigator of the \u201cCombined Thrombectomy for Distal MediUm Vessel Occlusion StroKe (DUSK)\u201d trial. Funding for this project is provided by Stryker Neurovascular. RGN is an investor in Viz-AI, Perfuze, Cerebrotech, Reist\/Q\u2019Apel Medical, Truvic, Tulavi Therapeutics, Vastrax, Piraeus Medical, Brain4Care, Quantanosis AI, and Viseon. JKB is consultant for Stryker, Medtronic, Cerenovus, Microvention, Q\u2019Apel Medical, BALT, Siemens. RZ is partially supported by an NIH-NINDS award (R01NS128986). CMS has research grants from Medtronic, Stryker, Penumbra, Cerenovus, Route 92, MIVI, Balt, Microvention, NICO, NIH\/NINDS, and consulting agreements with Medtronic, Stryker, Viz.ai, Balt, Microvention, Werfen and ownership of NTI, Reist.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The Geisinger IRB approved the study (2022-0571), additional individual site IRBs were in place as well as data use agreements for de-identified data. Consent was waived due to the retrospective nature of the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}