{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T16:59:27Z","timestamp":1785257967382,"version":"3.55.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,7,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Early reperfusion and first\u2010pass effect are key procedural end points in large\u2010vessel occlusion stroke thrombectomy. Because of greater fibrin specificity, tenecteplase may achieve higher early reperfusion rates compared with alteplase, yet impact of thrombolytic agents on first\u2010pass effect remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Consecutive patients with anterior circulation large\u2010vessel occlusion stroke receiving intravenous thrombolysis before endovascular treatment at 2 US stroke centers were reviewed. Early reperfusion was defined as extended Thrombolysis in Cerebral Infarction \u22652b50 on initial angiography. First\u2010pass effect was defined as extended Thrombolysis in Cerebral Infarction 2c\u20103 after a single pass. Multivariable logistic regression identified predictors of early reperfusion and first\u2010pass effect. Ordinal logistic regression assessed associations of thrombolytic agent, early reperfusion, and first\u2010pass effect with 90\u2010day modified Rankin Scale shift.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">Among 299 patients (tenecteplase 201, alteplase 98), early reperfusion occurred in 60 (20.1%) and was more frequent with tenecteplase compared with alteplase (24.4% versus 11.2%; adjusted odds ratio [OR], 2.31 [95% CI, 1.07\u20134.98]). Patients without early reperfusion were evaluated for first\u2010pass effect. Of 237 patients, first\u2010pass effect was less frequent with tenecteplase compared with alteplase (30.3% versus 40.2%; adjusted OR, 0.42 [95% CI, 0.23\u20130.79]). Early reperfusion and first\u2010pass effect each independently predicted better functional outcome, but functional outcomes were similar between tenecteplase and alteplase overall.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">We observed higher early reperfusion rates with tenecteplase, but greater first\u2010pass effect with alteplase, while functional outcomes were comparable. This may suggest that the early reperfusion advantage of tenecteplase could be offset by downstream procedural variables such as first\u2010pass effect, highlighting the importance of jointly evaluating\u00a0both reperfusion and procedural efficiency when comparing thrombolytic strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.047112","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T03:22:05Z","timestamp":1783740125000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Trade\u2010Off Between Early Reperfusion and First\u2010Pass Effect With Tenecteplase Versus Alteplase Before Stroke Thrombectomy"],"prefix":"10.1161","volume":"15","author":[{"given":"Tyler M.","family":"Bielinski","sequence":"first","affiliation":[{"name":"Geisinger Commonwealth School of Medicine","place":["Scranton"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0203-0960","authenticated-orcid":false,"given":"Kelsey E.","family":"Kline","sequence":"additional","affiliation":[{"name":"Geisinger Commonwealth School of Medicine","place":["Scranton"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica N.","family":"Bohl","sequence":"additional","affiliation":[{"name":"Geisinger Commonwealth School of Medicine","place":["Scranton"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant N.","family":"Badger","sequence":"additional","affiliation":[{"name":"Geisinger Commonwealth School of Medicine","place":["Scranton"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sina","family":"Hemmer","sequence":"additional","affiliation":[{"name":"Geisinger Medical Center","place":["Danville"]},{"name":"Geisinger","place":["Danville"]},{"name":"Department of Neurosurgery","place":["Geisinger, Wilkes\u2010Barre"]},{"name":"Geisinger Wyoming Valley Medical Center","place":["Geisinger, Wilkes\u2010Barre"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wysteria","family":"Stedman","sequence":"additional","affiliation":[{"name":"Geisinger","place":["Danville"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oded","family":"Goren","sequence":"additional","affiliation":[{"name":"Geisinger Medical Center","place":["Danville"]},{"name":"Geisinger","place":["Danville"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7006-1285","authenticated-orcid":false,"given":"Jiang","family":"Li","sequence":"additional","affiliation":[{"name":"Weis Center for Research","place":["Geisinger, Danville"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1743-8781","authenticated-orcid":false,"given":"Clemens M.","family":"Schirmer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery","place":["Geisinger, Wilkes\u2010Barre"]},{"name":"Geisinger Wyoming Valley Medical Center","place":["Geisinger, Wilkes\u2010Barre"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0017-5049","authenticated-orcid":false,"given":"Philipp","family":"Hendrix","sequence":"additional","affiliation":[{"name":"Geisinger Medical 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