Tenecteplase versus Alteplase and First-Pass Reperfusion in Endovascular Thrombectomy
Bibliographic record
Abstract
BACKGROUND AND PURPOSE: It is unknown whether thrombolysis with IV tenecteplase before endovascular thrombectomy (EVT) influences the probability of first-pass reperfusion when compared with IV alteplase. Therefore, we evaluated the effect of IV thrombolytic choice on this outcome. MATERIALS AND METHODS: We investigated the effects of thrombolytic agent (IV tenecteplase or IV alteplase) on first-pass reperfusion in EVT patients from the Alteplase Compared to Tenecteplase in Patients with Acute Ischemic Stroke (AcT) trial. The primary outcome was first-pass reperfusion, defined as expanded Thrombolysis in Cerebral Infarction (eTICI) score 2c-3 with a single thrombectomy pass. Secondary outcomes were modified first-pass reperfusion (eTICI 2b-3 after 1 pass), final eTICI score, total number of thrombectomy passes, and time from arterial access to successful reperfusion. Univariable models and generalized linear mixed-effects models with a logit link function were constructed. RESULTS: Among the 506 patients who underwent EVT in the AcT trial, 445 patients were included (230 [51.7%] women; median [interquartile range {IQR}] age, 73 [63–81]). Two hundred twenty-six (50.8%) received IV tenecteplase and 219 patients received IV alteplase (49.2%). First-pass reperfusion and modified first-pass reperfusion was achieved in 169 (38.0%) and 245 (55.1%) patients, respectively. First-pass reperfusion was achieved in 79 (35.0%) IV tenecteplase and 90 (41.1%) IV alteplase patients (P = .20). Modified first-pass reperfusion was achieved in 123 (54.4%) IV tenecteplase and 122 (55.7%) IV alteplase patients (P = .85). Median (IQR) number of passes was 2 (1–3) in the tenecteplase group and 1 (1–2) in the alteplase group (P = .07). Median (IQR) time from arterial access to successful reperfusion was 36 (25–59) minutes and 34 (21–49) minutes in the tenecteplase and alteplase groups, respectively (P = .07). There was no difference in final eTICI 2c-3 scores. There were no significant interactions between sex, occlusion site, thrombus length, residual flow, clot burden score, hyperattenuated artery sign, or first-line thrombectomy technique with thrombolysis type on first-pass reperfusion. CONCLUSIONS: IV thrombolytic agent did not influence the probability of first-pass reperfusion.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".