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ESOC 2023 | Alteplase vs tenecteplase in MeVO strokes: results from AcT

The Alteplase compared to Tenecteplase (AcT) trial was published in 2022, demonstrating tenecteplase to be non-inferior to alteplase for intravenous thrombolysis (IVT) after acute ischemic stroke, with comparable good functional outcome (mRS 0-1 at 90-120 days) rates in each trial arm. Fouzi Bala, MD, MSc, University of Calgary, Alberta, Canada, shares the findings of a substudy looking at the efficacy and safety of tenecteplase compared to alteplase in acute ischemic stroke due to medium vessel occlusion (MeVO) in the AcT trial. In total, 455 patients had MeVO, including M2/M3-MCA, P2/P3-PCA, and A2/A3-ACA occlusions. It was demonstrated that tenecteplase had comparable safety and efficacy to alteplase in this population, with rates of 90-day mRS 0-1, symptomatic intracerebral hemorrhage, and mortality similar in each arm. In patients that underwent endovascular thrombectomy, rates of successful reperfusion were significantly higher in patients who received tenecteplase, compared to alteplase. This interview took place during the European Stroke Organisation Conference (ESOC) in Munich, Germany.

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