Introduction: Landmark clinical trials have examined the safety and efficacy of tenecteplase, demonstrating non-inferiority when compared to intravenous alteplase in the 1.8 and an absolute difference >15 mL) on CT perfusion. Occlusion site was categorized into: ICA + proximal M1, distal M1, proximal M2, distal M2, M3 and beyond, ACA, and PCA. Patients enrolled into TASTE did not receive endovascular therapy. Primary outcome was mRS 0-1 at 90 days. The treatment effect of tenecteplase and alteplase was compared, stratifying by occlusion site, and adjusting for age, baseline NIHSS and pre-morbid mRS in modified Poisson regression models. Results: Of the 601 patients included in the primary analysis, 295 (49%) received tenecteplase and 306 (51%) received alteplase. Tenecteplase was associated with a higher odds of mRS 0-1 with distal (M3 and beyond) occlusions (tenecteplase: 62/81 76% vs. alteplase: 59/93 63%, aRR: 1.23 95% CI: 1.04-1.46). Rates of 90-day mRS 0-1 were comparable for proximal M2 (tenecteplase: 27/48 56% vs. alteplase: 29/50 58%, aRR: 1.02 95% CI: 0.74-1.41) and distal M2 occlusions (tenecteplase: 30/46 65% vs. alteplase: 28/48 58%, aRR: 1.14 95% CI: 0.84-1.54). No difference in tenecteplase treatment effect was observed for anterior (tenecteplase: 12//21 57% vs. alteplase: 5/13 38%, aRR: 1.45 95% CI: 0.70-2.99) or posterior cerebral artery (tenecteplase: 21/46 46% vs. alteplase: 22/46 47%, aRR: 0.92 95% CI: 0.62-1.36) occlusions. Conclusion: Patients with more distal MCA occlusions (M3 and beyond) who are treated with tenecteplase are more likely to achieve mRS 0-1 at 90 days than those treated with alteplase. Differences in treatment effect with more proximal MCA and posterior cerebral artery occlusions were not observed.
Yogendrakumar et al. (Thu,) studied this question.