Abstract TP10: Realtime Tenecteplase Recanalization Rates And Clinical Outcomes In Patients With Medium Vessel Occlusion Stroke

Abstract

Introduction: The goal of this study was to evaluate recanalization rates, incidence of hemorrhagic transformation, and clinical outcomes in patients with medium vessel occlusion (MVO) strokes receiving tenecteplase (TNK) and endovascular treatment (EVT) to add to the growing fund of knowledge of TNK in AIS. Methods: We conducted a retrospective cohort study of prospectively collected AIS patients who received TNK and EVT from October 2020 to June 2022 at our comprehensive stroke center. We included subjects with MVO defined as occlusion of the M2 segment or more distal of the middle cerebral artery without involvement of the M1 segment, A1 segment or more distal of the anterior cerebral artery, or P1 segment or more distal of the posterior cerebral artery. Patients receiving intra-arterial thrombolytics or non-thrombolytics were excluded. We defined successful recanalization as Modified Thrombolysis in Cerebral Infarction (mTICI) 2b or greater and symptomatic hemorrhage as change in NIHSS ≥ 4 with temporally associated hemorrhage. Hemorrhagic transformation was classified using ECASS-3 criteria. Social science statistics software was used for data analysis. Results: Out of 77 patients who received TNK and EVT, 16 subjects had MVO and were included in analysis. Mean age was 68.56 (95% CI 60.20, 76.93). Fifty six percent (n=9) of subjects were female. Median presenting NIHSS was 10.5 (95% CI 7.17, 14.07). Median 90 day mRS was 1 (95% CI 0.76, 2.62). No subject recanalized prior to EVT. Hemorrhagic transformation occurred in 43.75% (n=7) of subjects, and symptomatic intracerebral hemorrhage (ICH) occurred in 1 subject (6.25%) with PH-2. There was no ICH in subjects who did not recanalize post-EVT (n=3). No significant change was found from baseline NIHSS compared to discharge NIHSS (U=95.5, z=1.21, p=0.11). Conclusions: TNK in MVO may be associated with increased risk of hemorrhagic transformation. However, given that all subjects underwent EVT and the known incidence of post-procedural contrast staining on CT, the incidence of asymptomatic hemorrhagic transformation may be overestimated. This is further supported by good clinical outcomes and low incidence of symptomatic ICH.