浙江大学学报（医学版）2026，Vol.55Issue(2)：121-128,8.DOI:10.3724/zdxbyxb-2025-0639
替奈普酶与阿替普酶静脉溶栓桥接机械取栓治疗合并大血管闭塞急性缺血性脑卒中患者效果比较
Comparison of functional outcomes between tenecteplase and alteplase as bridging thrombolysis prior to mechanical throm-bectomy for acute ischemic stroke patients with large vessel occlusion
摘要
Abstract
Objective:To compare the efficacy and safety of tenecteplase versus alteplase as bridging intravenous thrombolysis before mechanical thrombectomy in acute ischemic stroke(AIS)patients with large vessel occlusion.Methods:In this retrospective cohort study,data were extracted from the Acute Stroke Patients for Stroke Management Quality Evaluation online database(CASE-Ⅱ,NCT04487340).Patients with AIS and large vessel occlusion who received tenecteplase or alteplase followed by mechanical thrombectomy within 24 hours of symptom onset from December 2022 to March 2025 were included.The patients were divided into the tenecteplase group and the alteplase group.Propensity score matching(1∶4)was performed based on age,sex,door-to-needle time(DNT),door-to-puncture time(DPT),and onset-to-door time.Binary logistic regression and general linear models were used to compare 3-month functional and safety outcomes.Sensitivity analysis was conducted for patients with onset-to-needle time(ONT)≤4.5 h,and subgroup analyses were performed based on age,sex,baseline National Institutes of Health Stroke Scale(NIHSS)score,occlusion site,DNT and DPT.Results:Among 1505 enrolled patients,250 received tenecteplase and 1255 received alteplase.No significant differences were observed in 3-month functional outcomes between the two groups(all P>0.05).However,the tenecteplase group had lower 3-month all-cause mortality(OR=0.676,95%CI:0.470-0.972,P=0.032).After matching,224 tenecteplase-treated and 767 alteplase-treated patients were included.There were no significant differences in functional or safety outcomes between the two groups(all P>0.05).Sensitivity analysis showed that among patients with an onset-to-needle time(ONT)≤4.5 hours,there were no statistically significant differences in 3-month functional or safety outcomes between the tenecteplase group and the alteplase group(all P>0.05).Subgroup analyses indicated that no statistically significant differences in 3-month functional independence were observed across all subgroups(all P>0.05).Conclusion:In AIS patients with large vessel occlusion undergoing bridging thrombolysis before mechanical thrombectomy,tenecteplase and alteplase showed comparable 3-month functional and safety outcomes.关键词
急性缺血性脑卒中/大血管闭塞/替奈普酶/阿替普酶/机械取栓/临床结局/安全性/回顾性研究Key words
Acute ischemic stroke/Large vessel occlusion/Tenecteplase/Alteplase/Mechanical thrombectomy/Clinical outcome/Safety/Retrospective study分类
医药卫生引用本文复制引用
施政浩,杨建生,卢振产,蔡耀杰,朱益,黄龚春,朱晖,楼敏,程建华..替奈普酶与阿替普酶静脉溶栓桥接机械取栓治疗合并大血管闭塞急性缺血性脑卒中患者效果比较[J].浙江大学学报（医学版）,2026,55(2):121-128,8.基金项目
浙江省医学会临床医学专项资金(2023ZYC-A194) （2023ZYC-A194）
浙江省基础公益研究计划(LY23H090011)This study was supported by Zhejiang Medical Association Clinical Research Fund (2023ZYCA194) and Basic Public Welfare Research Program of Zhejiang Province (LY23H090011) （LY23H090011）
