PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 42432425

Trade-Off Between Early Reperfusion and First-Pass Effect With Tenecteplase Versus Alteplase Before Stroke Thrombectomy.

Tyler M Bielinski·Kelsey E Kline·Veronica N Bohl·Grant N Badger·Sina Hemmer·Wysteria Stedman·Oded Goren·Jiang Li·Clemens M Schirmer·Philipp Hendrix
View original source ↗Export metadata ↓

Abstract

BACKGROUND: Early reperfusion and first-pass effect are key procedural end points in large-vessel 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-pass effect remains unclear. METHODS: Consecutive patients with anterior circulation large-vessel 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 ≥2b50 on initial angiography. First-pass effect was defined as extended Thrombolysis in Cerebral Infarction 2c-3 after a single pass. Multivariable logistic regression identified predictors of early reperfusion and first-pass effect. Ordinal logistic regression assessed associations of thrombolytic agent, early reperfusion, and first-pass effect with 90-day modified Rankin Scale shift. RESULTS: 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, 1.07-4.98]). Patients without early reperfusion were evaluated for first-pass effect. Of 237 patients, first-pass effect was less frequent with tenecteplase compared with alteplase (30.3% versus 40.2%; adjusted OR, 0.42 [95% CI, 0.23-0.79]). Early reperfusion and first-pass effect each independently predicted better functional outcome, but functional outcomes were similar between tenecteplase and alteplase overall. CONCLUSIONS: We observed higher early reperfusion rates with tenecteplase, but greater first-pass 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-pass effect, highlighting the importance of jointly evaluating both reperfusion and procedural efficiency when comparing thrombolytic strategies.

Explore related subjects

HumansTenecteplaseTissue Plasminogen ActivatorFibrinolytic AgentsFemaleMaleThrombectomyAgedTreatment OutcomeTime FactorsThrombolytic TherapyRetrospective StudiesMiddle AgedReperfusionAged, 80 and overLogistic ModelsStrokeOdds RatioIschemic StrokeMultivariate Analysisalteplaseearly reperfusionlarge‐vessel occlusion stroketenecteplaseJournal ArticleComparative StudyMulticenter StudyResearch Support, Non-U.S. Gov't

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Tyler M Bielinski, Kelsey E Kline, Veronica N Bohl, Grant N Badger, Sina Hemmer, Wysteria Stedman, Oded Goren, Jiang Li, Clemens M Schirmer, Philipp Hendrix. 2026-07-10. Trade-Off Between Early Reperfusion and First-Pass Effect With Tenecteplase Versus Alteplase Before Stroke Thrombectomy.. https://doi.org/10.1161/jaha.125.047112

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2027

Global Genomic Surveillance.

Global genomic surveillance has emerged as a foundational pillar of public health in the twenty-first century, enabling real-time tracking of pathogen evolution and informing outbreak response. This chapter examines the strategic architecture of global genomic surveillance, focusing on its application to arboviruses such as chikungunya virus (CHIKV). It explores the integration of genomic data with epidemiological, clinical, and environmental information within a One Health framework, while addressing critical challenges in governance, equity, and interoperability. The discussion covers the entire genomic surveillance workflow, from sample collection and sequencing to bioinformatic analysis and phylogenetic inference, and highlights the transformative role of artificial intelligence (AI) in predictive surveillance. By analyzing global initiatives, operational barriers, and emerging technologies, this chapter underscores the necessity of sustainable, equitable, and interoperable genomic systems to proactively address current and future infectious disease threats.

Humans↗
PubMed2027

Systematic Dissection of Key Driver Perturbation Signatures in Single Cells via ECCITE-seq.

CRISPR screens, such as expanded CRISPR-compatible cellular indexing of transcriptomes and epitopes by sequencing (ECCITE-seq), enable the simultaneous measurement of transcriptomes, gRNA identity, and cell-surface protein expression at single-cell resolution to systematically interrogate gene function. This platform provides a powerful and scalable experimental approach for validating disease-associated regulators identified by large-scale association studies and other computational methods, including network-based analyses of multi-omics data. Here, as an example application, we describe an ECCITE-seq framework to characterize the transcriptomic consequences of perturbing multiple neuronal key driver genes associated with Alzheimer's disease (AD) in human-induced pluripotent stem cell (hiPSC)-derived neurons. More broadly, by integrating customized pooled gRNA libraries with different CRISPR effectors across multiple cell types, this approach allows for the assessment of the regulatory impact of candidate genes implicated in development and disease processes.

Humans↗
PubMed2027

Identification of Genome-Wide Chromatin Structural Aberration in Cancer by Hi-C Analysis.

Aberrant three-dimensional genome organization is a hallmark of cancer, often driving oncogene activation through mechanisms such as enhancer hijacking. High-throughput chromosome conformation capture (Hi-C) maps these interactions on a genome-wide scale. Unlike earlier dilution-based methods, in situ Hi-C performs proximity ligation within intact nuclei, minimizing random ligation noise and enabling fine-scale structure detection. This chapter describes an optimized in situ Hi-C protocol tailored for cancer cell lines using MboI digestion and biotin-mediated pull-down to generate high-complexity libraries. We further outline a computational workflow that extends beyond standard topological mapping of compartments and topologically associating domains to identify cancer-specific aberrations. Specifically, we focus on detecting chromosomal rearrangements (structural variants) and characterizing the distinct circular topology of extrachromosomal DNA. This integrated experimental and analytical framework provides the necessary tools to dissect the spatial dysregulation underlying tumor evolution.

Humans↗