Tenecteplase和Alteplase在串联性脑卒中患者中的安全性和有效性:EXTEND-IA TNK试验的事后分析[j] . Neurology . doi: 10.1212/WNL.0000000000207138首页Sp - 10.1212/ wnl.0000000000207138非盟- Vignan Yogendrakumar盟——列昂尼德•Churilov盟——彼得·J·米切尔AU - Timothy J Kleinig盟Nawaf Yassi AU -文森特Thijs AU -泰迪吴盟沾光沙非盟-彼得·贝利盟-海伦M杜威盟-菲利普MC崔AU -马爱丽丝盟Tissa韦杰云盟盟-卡洛斯Garcia-Esperon盟杰弗里- Ronil诉钱德拉盟丹尼斯约翰Cordato AU -伯纳德燕DMedSc盟Gagan Sharma盟谈话马克W帕森斯-帕特里夏·米德斯蒙德盟盟——杰弗里·艾伦唐南AU -斯蒂芬·M·戴维斯盟布鲁斯·c·V。背景与目的:tenecteplase治疗串联性脑卒中患者的安全性和有效性尚不清首页楚。我们对串联病变患者的替替普酶和阿替普酶进行了比较分析。方法:我们首先使用EXTEND-IA TNK试验的个体患者数据比较了替奈普酶和阿替普酶对串联病变患者的治疗效果。我们用有序logistic和Firth回归模型评估了初次血管造影评估和90天mRS时的颅内再灌注情况。由于在EXTEND-IA TNK试验中接受阿替普酶治疗的患者中，死亡率和症状性颅内出血这两个关键结果很少，因此我们通过对系统评价中确定的研究进行荟萃分析获得的发生率估计来补充试验数据，从而对这些结果进行汇总估计。然后，我们计算了未经调整的风险差异，将接受阿替普酶的患者的汇总估计值与试验中观察到的接受替替普酶的患者的发病率进行比较。结果:在EXTEND-IA TNK试验中，483例患者中有71例(15%)具有串联病变。在双列病变患者中，替替普酶治疗组11/56(20%)与阿替普酶治疗组1/15(7%)患者观察到颅内再灌注(aOR: 2.19; 95% CI:0.28-17.29). No significant difference in 90-day mRS was observed (adjusted common OR: 1.48; 95% CI: 0.44-5.00). A pooled study-level proportion of alteplase associated mortality and symptomatic intracranial hemorrhage was 0.14 (95% CI: 0.08-0.21) and 0.09 (95% CI: 0.04-0.16), respectively. Compared to a mortality rate of 0.09 (95% CI: 0.03-0.20) and a symptomatic intracranial hemorrhage rate of 0.07 (95% CI: 0.02-0.17) in tenecteplase treated patients, no significant difference was observed.Conclusions: Functional outcomes, mortality, and symptomatic intracranial hemorrhage did not significantly differ between tenecteplase and alteplase treated tandem lesion patients.Classification of Evidence: This study provides Class III evidence that tenecteplase is associated with similar rates of intracranial reperfusion, functional outcome, mortality, and symptomatic intracranial hemorrhage compared with alteplase, in patients with acute stroke due to tandem lesions. However, the confidence intervals do not rule out clinically important differences. ER -