{
  "abstract": "Background Thrombus migration can occur in patients receiving IV thrombolysis for acute stroke. This study compared the effects of IV tenecteplase (0.25 mg/kg) versus alteplase (0.9 mg/kg) on thrombus movement in patients undergoing endovascular treatment (EVT) in the AcT trial.Methods Patients with intracranial occlusion on baseline CT angiography (CTA) who underwent EVT were included. Thrombus movement from baseline CTA to first angiographic EVT run was classified as no thrombus movement, thrombus extension (TE, movement to a proximal location on DSA compared with CTA), thrombus migration (TM, movement to a more distal location), or recanalization. Outcomes were 90-day modified Rankin Scale (mRS) score 0–2 and final extended Thrombolysis in Cerebral Infarction score 2b–3. Mixed-effects logistic regression was performed.Results Of the 1577 patients in the AcT trial, 496 patients with intracranial occlusions underwent EVT (median age 73 years, 50.8% female). No thrombus movement was seen in 398 patients (80.2%), TE in six (1.2%), TM in 77 (15.5%), and complete recanalization in 15 (3.0%). Tenecteplase recipients (n=252) had higher TM rates than alteplase recipients (19.4% vs 11.5%, adjusted OR (aOR) 1.83, 95% CI 1.10 to 3.07). TM did not impact final successful reperfusion (aOR 0.76, 95% CI 0.40 to 1.38) but was associated with increased odds of 90-day mRS 0–2 (aOR 1.77, 95% CI 1.05 to 3.06). Thrombolytic type did not affect the relationship between thrombus movement and study outcomes (P>0.05).Conclusion IV tenecteplase is associated with higher thrombus migration rates before EVT compared with alteplase, which is linked to better functional outcomes. However, the type of thrombolytic agent did not affect final reperfusion and functional outcomes.",
  "authors": [
    {
      "affiliations": [
        "Department of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Ibrahim Alhabli"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Noman Ishaque"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Mahesh Kate"
    },
    {
      "affiliations": [
        "Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Anas Alrohimi"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Nishita Singh"
    },
    {
      "affiliations": [
        "Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands"
      ],
      "name": "Faysal Benali"
    },
    {
      "affiliations": [
        "Department of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "MacKenzie Horn"
    },
    {
      "affiliations": [
        "Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada"
      ],
      "name": "Brian Buck"
    },
    {
      "affiliations": [
        "Department of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Ayoola Ademola"
    },
    {
      "affiliations": [
        "Department of Medicine (Division of Neurology), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Houman Khosravani"
    },
    {
      "affiliations": [
        "Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario, Canada"
      ],
      "name": "Ramana Appireddy"
    },
    {
      "affiliations": [
        "Department of Neurology, Université de Sherbrooke, Sherbrooke, Nova Scotia, Canada"
      ],
      "name": "Francois Moreau"
    },
    {
      "affiliations": [
        "Department of Neurology, Queen Elizabeth Health Sciences Centre, Halifax, Nova Scotia, Canada"
      ],
      "name": "Gordon Gubitz"
    },
    {
      "affiliations": [
        "Department of Neurology, Kelowna General Hospital, Kelowna, British Columbia, Canada"
      ],
      "name": "Aleksander Tkach"
    },
    {
      "affiliations": [
        "Department of Neurology, McMaster University, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada"
      ],
      "name": "Luciana Catanese"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Ottawa and the Ottawa Heart Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Dariush Dowlatshahi"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Aleksandra Pikula"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Jai J Shankar"
    },
    {
      "affiliations": [
        "Department of Neurology, Queen Elizabeth Hospital, Charlottetown, Edward, Canada"
      ],
      "name": "Heather Williams"
    },
    {
      "affiliations": [
        "The University of British Columbia, Vancouver Stroke Program and the Division of Neurology, Vancouver, British Columbia, Canada"
      ],
      "name": "Thalia S Field"
    },
    {
      "affiliations": [
        "Department of Neurology, St Michael's Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Atif Zafar"
    },
    {
      "affiliations": [
        "Department of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Tolulope Sajobi"
    },
    {
      "affiliations": [
        "Department of Medicine (Division of Neurology), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Richard Swartz"
    },
    {
      "affiliations": [
        "Department of Neurology, CHUM - Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada"
      ],
      "name": "Alexandre Y Poppe"
    },
    {
      "affiliations": [
        "Department of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Andrew M Demchuk"
    },
    {
      "affiliations": [
        "Department of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Bijoy K Menon"
    },
    {
      "affiliations": [
        "Department of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Mohammed Almekhlafi"
    },
    {
      "affiliations": [
        "Department of Clinical Neurosciences and Radiology, University of Calgary, Calgary, Alberta, Canada",
        "Diagnostic and Interventional Neuroradiology Department, University Hospital of Tours, Tours, France"
      ],
      "name": "Fouzi Bala"
    }
  ],
  "title": "Intravenous tenecteplase is associated with a higher incidence of thrombus movement before endovascular treatment for acute ischemic stroke: a secondary analysis of the AcT randomized controlled trial",
  "uid": "59f0680c-3477-5c41-9747-d38182ee4852"
}