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Background: In acute ischemic stroke (AIS), the treatment window for thrombolytics is 4.5 hours from symptom onset. Tenecteplase, a modified tissue plasminogen activator, may be effective over an extended treatment window (4.5–24 hours). Hence, a meta-analysis was performed to evaluate tenecteplase use within an extended treatment window.Methods: Databases were searched for articles published before July 3, 2024. Randomized controlled trials (RCTs) that compared tenecteplase treatment in an extended treatment window with the current standard of care were included. The endpoints were excellent functional outcomes (modified Rankin Scale [mRS] 0–1) at 90 days, National Institutes of Health Stroke Scale (NIHSS) score change at 24 hours and 7 days, and symptomatic intracranial hemorrhage (sICH) at 90 days. The pooled risk ratio (RR) and mean difference (MD) were calculated for categorical and continuous outcomes, respectively.Results: Four RCTs involving 1,629 patients with AIS were included. High-quality evidence indicated that tenecteplase achieved a higher likelihood of mRS 0–1 at 90 days (RR, 1.21; 95% confidence interval [CI], 1.06 to 1.38; P=0.004) and a lower NIHSS score change at 24 hours (MD, −0.84; 95% CI, −1.40 to −0.27; P=0.003) than that of the placebo. Low-quality evidence showed that tenecteplase reduced the NIHSS score change at 7 days (MD, −0.79; 95% CI, −1.56 to −0.03; P=0.04). No differences in sICH or mortality were observed.Conclusion: Tenecteplase compared favorably with non-thrombolytic therapy in an extended treatment window. Future RCTs may establish tenecteplase as the standard of care for up to 24 hours.

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기사명 저자명 페이지 원문 목차
Use of quantitative pupillometry in the neuro intensive care unit setting Alizabeth York, Farial Rahman, Andrew Bauerschmidt p. 41-51
Efficacy and safety of tenecteplase for acute ischemic stroke within an extended treatment window : a systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials Hesham Kelani, Mohamed R. Abdelraouf, Hazem Mohamed Salamah, Eli Berglas, Toka Elboraay, Abdelrahman Mahmoud, Mohamed Abugdida, Nadia Albaramony, Ahmed Abd Elazim, Diana Greene-Chandos ... [et al.] p. 52-63
Transcutaneous auricular vagus nerve stimulation reduces hospital cost of aneurysmal subarachnoid hemorrhage management : secondary analysis of the NAVSaH trial Michael O Olufawo, Karan Joseph, Matthew Greever, Jason Gagne, Alan Dow, Andrew Pierce, Mahendra Gupta, Anna L Huguenard, Eric C Leuthardt p. 64-74
Trajectories of 24-hour heart rate and hemorrhagic transformation in patients receiving intravenous thrombolysis for acute ischemic stroke Chudhadhorn Hantrakul, Pat Korathanakhun, Veerapong Vattanavanit p. 75-83
Epidural pressure is a major driver of elevated intraspinal pressure after traumatic spinal cord injury and laminectomy in pigs Nicholas Østergaard Olsen, Mathias Møller Thygesen, Seyar Entezari, Nanna Kaae Houlind, Mathias Skov, Michael Pedersen, Mikkel Mylius Rasmussen p. 84-94
Effect of a nurse-led sedation protocol on sedation quality in patients with traumatic brain injury : a randomized trial Ahmad Mustafa Al-Bkkour, Reda Khuder Al-Omar, Samer Ibrahim Kabba, Warda Ramadan Abou Zied p. 95-105
(A) case of atypical neuroleptic malignant syndrome following depot antipsychotic withdrawal in an elderly female : a diagnostic and therapeutic challenge Rimaz AlHamwi, Ola Shamsin, Raneem Alsabbagh, Mazen Qusaibaty p. 106-110
Extracorporeal membrane oxygenation for Guillain-Barré syndrome : a case report Mary A. Kraybill, John Weimer, Theodore Loftsgard, Jeremy Grate p. 111-114
Anti-Yo–associated paraneoplastic cerebellar degeneration revealing appendiceal adenocarcinoma : a case report with complete neurological recovery Ümitcan Ateş p. 115-119
Life-threatening arrhythmias in children with elevated intracranial pressure : a case series and literature review Siddannagoud Salotagi, Atul Jindal, Manas Ranjan Sahoo, Shubham Verma, Santosh Navi p. 120-126
Brain multimonitoring in a patient affected by severe cerebral malaria from Plasmodium falciparum : a case report Ludovic van Delden, Maxime Baroz, Pia De Stefano, Giulio Degano, Hervé Quintard, Tommaso Rochat Negro p. 127-133
Management of polyautoimmune crisis involving myasthenic crisis and lupus flare using plasma exchange : a case report Aldy Sethiono, IGAG Utara Hartawan, Pontisomaya Parami, Tjokorda Gde Agung Senapathi p. 134-141
Euglycemic diabetic ketoacidosis in a neurosurgical patient on empagliflozin : a case report Said S. Tarraf, William J. Weir, Kevin R. Olsen p. 142-146
Reversible cortical lesions and status myoclonus in hepatic encephalopathy : caution in prognostication Elisabeth Van Boxstael, Eric Vigneul, Alexane Fierain, Antoine Guilmot p. 147-149

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