Abstract TMP86: Effects of Tenecteplase versus Alteplase in Stroke Patients With Large Vessel Occlusions Who Achieve Full Recanalization

Abstract

Introduction: Tenecteplase improves reperfusion and functional outcomes in stroke patients with large vessel occlusion. TNK is more specific for fibrin than TPA, however, it is unclear if this effect could increase efficacy of mechanical thrombectomy (MT). We aimed to determine if TNK is associated with higher recanalization rates and better clinical outcomes than TPA in patients who undergo MT. Methods: Electronic medical record review of acute stroke patients with LVO, age over 18 years, who received both thrombolysis with either TNK or TPA, and underwent MT at a tertiary medical center from January 2017 to April 2023 was performed. Use of TPA was converted to TNK on 1/11/2022 per hospital policy. Number of passes and time to full recanalization (defined as TICI 3) were recorded. Primary outcome was mRS at 90 days. Secondary outcomes were NIHSS at 24 hours and at discharge. Primary safety outcome was parenchymal hematoma type 2 (PH2) intracerebral hemorrhage. A t-test was used to examine association between outcomes and thrombolysis type. Fischer’s exact test was used to determine differences in recanalization and hemorrhage rates. Results: Of the 284 patients included, 213 received TPA and 71 received TNK. Mean age was 68, and 50.0% were females. Forty-three patients (60.6%) who received TNK, and 96 patients (45.1%) who received TPA achieved TICI 3 score (P=0.028). There was no difference in time to recanalization (38.5 min versus 32 min, p=0.872), median number of passes (1 versus 1, p=0.934), median 90-day mRS (2 versus 1.5, p=0.434), or the rate of PH2 hemorrhage (0% versus 2.3%, p=0.336) for TNK vs TPA in patients with TICI 3 recanalization. Median NIHSS at presentation (18.0 versus 16.0, p=0.398), at 24 hours (8.0 versus 7.0, p=0.406), and at discharge (3.0 versus 4.0, p=0.383) were similar for all patients receiving TNK and TPA, respectively. Conclusions: In our retrospective analysis, TNK showed a higher rate of TICI 3 recanalization for patients with LVO, who both received thrombolysis and underwent MT. There was no difference between TNK and TPA for number of passes, time to recanalization, parenchymal hematoma rate, and clinical outcomes in patients who achieved TICI 3. Overall clinical outcomes were also similar, irrespective of recanalization grade.