Abstract / Summary
Background: Posterior circulation ischemic stroke (PCIS) is associated with substantial morbidity and mortality, and the optimal intravenous thrombolytic strategy in this subgroup remains unclear.
Methods: We searched databases for studies comparing intravenous tenecteplase with alteplase in adults with PCIS. The primary outcome was functional independence at 90 days (mRS 0-2). Secondary outcomes included other functional outcomes, reperfusion, hemorrhagic complications, and mortality.
Results: Five studies involving 997 patients were included. Regarding efficacy outcomes, tenecteplase was associated with a significantly greater likelihood of achieving an ambulatory functional outcome at 90 days (mRS 0-3) [RR 1.29, 95% CI 1.03-1.60; p = 0.02] and improved pre-EVT perfusion [RR 2.18, 95% CI 1.06-4.46; p = 0.03]. No significant differences were observed for excellent functional outcome (mRS 0-1) [RR 1.19, 95% CI 0.91-1.56; p = 0.20], functional independence (mRS 0-2) [RR 1.10, 95% CI 0.89-1.37; p = 0.39], or post-EVT perfusion [RR 1.12, 95% CI 0.89-1.40; p = 0.34]. Regarding safety outcomes, no significant differences were observed between tenecteplase and alteplase for symptomatic intracranial hemorrhage (sICH) [RR 0.89, 95% CI 0.36-2.22; p = 0.81], any intracranial hemorrhage [RR 1.02, 95% CI 0.59-1.78; p = 0.94], parenchymal hematoma [RR 0.76, 95% CI 0.24-2.38; p = 0.64], or 90-day mortality [RR 0.88, 95% CI 0.66-1.17; p = 0.39].
Conclusion: Tenecteplase may improve reperfusion and ambulatory recovery without increasing hemorrhagic complications or mortality compared with alteplase in PCIS, although larger PCIS-specific studies are needed.