{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T13:18:43Z","timestamp":1773321523537,"version":"3.50.1"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>With the increasing use of tenecteplase for acute ischemic stroke, it is important to determine its safety in young adults. We aimed to characterize the clinical characteristics and imaging findings of young adults (\u226445 years) in the AcT trial (Intravenous Tenecteplase Compared With Alteplase for Acute Ischaemic Stroke in Canada) and to compare their safety and efficacy outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This is a secondary analysis of the AcT trial, a phase 3 pragmatic multicenter registry-linked randomized controlled trial. We describe clinical and imaging characteristics of young adults with acute ischemic stroke. Logistic regression adjusted for sex and stroke severity was performed to assess safety and efficacy outcomes between the tenecteplase and alteplase arms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Of the 1577 enrolled patients, 68 (4.31%) were \u226445 years. Of 53 patients with available comorbidity data, 33 (62.26%) had no comorbidities. Hypertension was the most common comorbidity (n=8, 15%), whereas cardiac pathologies were observed in a smaller proportion (n=4, 7.5%). Intracranial atherosclerosis was identified in 7 patients (10%) and carotid or vertebral artery dissection in 6 patients (9%). Safety outcomes, including mortality, intracranial hemorrhage, and serious adverse events, were similar between the tenecteplase and alteplase arms. Excellent functional outcome (modified Rankin Scale score 0\u20131) at 90 days was better in the tenecteplase arm (84.72% versus 45%; adjusted odds ratio, 6.55 [95% CI, 1.89\u201322.71]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The majority of young adults presenting with acute ischemic stroke did not have any traditional risk factors for stroke at presentation. Safety outcomes were similar between the tenecteplase and alteplase arms. Although functional outcomes were observed to be better in the tenecteplase arm, these findings are exploratory and should be interpreted cautiously, given the study\u2019s limited sample size and lack of adjustment for key confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03889249.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/svin.125.001974","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T10:00:42Z","timestamp":1769076042000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Comparing Clinical Characteristics and Outcomes of Tenecteplase Versus Alteplase in Young Adult Patients With Stroke: A Secondary Analysis of the AcT Trial"],"prefix":"10.1161","volume":"6","clinical-trial-number":[{"clinical-trial-number":"nct03889249","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7263-8474","authenticated-orcid":true,"given":"Katrina Hannah D.","family":"Ignacio","sequence":"first","affiliation":[{"name":"Department of Clinical Neurosciences (K.H.D.I., F.B., A.A., T.T.S., M.H., M.D.H., B.K.M., M.A.A.), University of Calgary, Alberta, Canada."},{"name":"Department of Community Health Sciences (K.H.D.I., A.A., T.T.S., M.H., M.D.H., B.K.M., M.A.A.), University of Calgary, Alberta, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6748-2081","authenticated-orcid":true,"given":"Fouzi","family":"Bala","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences (K.H.D.I., F.B., A.A., T.T.S., M.H., M.D.H., B.K.M., M.A.A.), University of Calgary, Alberta, Canada."},{"name":"Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, France (F.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8696-5211","authenticated-orcid":true,"given":"Luciana","family":"Catanese","sequence":"additional","affiliation":[{"name":"Department of Medicine (Neurology), Hamilton Health Sciences Centre and McMaster University, Ontario, Canada (L.C.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4063-4431","authenticated-orcid":true,"given":"Aleksander","family":"Tkach","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Kelowna General Hospital, British Columbia, Canada (A.T.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4794-2882","authenticated-orcid":true,"given":"Mahesh","family":"Kate","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (M.K., B.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7984-6062","authenticated-orcid":true,"given":"Brian","family":"Buck","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (M.K., B.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8412-6246","authenticated-orcid":true,"given":"Ayoola","family":"Ademola","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences (K.H.D.I., F.B., A.A., T.T.S., M.H., M.D.H., B.K.M., M.A.A.), University of Calgary, Alberta, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5696-5552","authenticated-orcid":true,"given":"Tolulope T.","family":"Sajobi","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences (K.H.D.I., F.B., A.A., T.T.S., M.H., M.D.H., B.K.M., M.A.A.), University of Calgary, Alberta, Canada."},{"name":"Department of Community Health Sciences (K.H.D.I., A.A., T.T.S., M.H., M.D.H., B.K.M., M.A.A.), University of Calgary, Alberta, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1176-0633","authenticated-orcid":true,"given":"Thalia S.","family":"Field","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada (T.S.F.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7077-0148","authenticated-orcid":true,"given":"Aleksandra","family":"Pikula","sequence":"additional","affiliation":[{"name":"Department of Medicine (Neurology), University Health Network, Krembil Brain Institute, JS Sonshine Center (A.P.), University of Toronto, Ontario, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0085-6816","authenticated-orcid":true,"given":"Michel","family":"Shamy","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Medicine, University of Ottawa, 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