Abstract WP22: “Chopperlysis:” Improved Functional Outcomes Associated With Helicopter Transport in Large Vessel Occlusion Stroke Patients Treated With Tenecteplase

Abstract

Introduction: Tenecteplase (TNK) is increasingly being utilized for IV thrombolysis in acute ischemic stroke, including for patients with large vessel occlusion (LVO) prior to transfer to an endovascular thrombectomy (EVT) capable center (TCC). However, there is limited data regarding factors that influence functional outcome between the time of TNK administration and TCC arrival. The purpose of this analysis is to characterize the effect of the arrival method on the effectiveness of TNK to improve patient outcomes. Methods: A retrospective registry of stroke patients between 2019-2023 at a single comprehensive stroke center was queried. Patients with LVO stroke who had complete data for method of arrival (i.e. ground transportation versus helicopter), TNK treatment, and available 90-day modified Rankin score (mRS) were included. The primary outcome was a favorable 90-day mRS of 0-2. Categorical variables were reported as frequencies, and associations across variables were analyzed using Chi-square test or Fisher's exact test. Odds ratios were calculated with univariate logistic regressions. Results: Of 2675 patients meeting inclusion criteria, 14.4% arrived by helicopter and 85.6% arrived by ground transportation. 174 (6.5%) were treated with TNK, including 5.1% of ground transported patients and 14.1% of air transported patients. Irrespective of EVT, patients arriving by ground did not differ in likelihood of achieving the primary outcome whether they did or did not receive TNK (53.9% TNK vs. 48.4% no TNK, p=0.35). However, patients arriving by helicopter had a significantly higher likelihood of achieving the primary outcome with TNK, regardless of EVT (60% TNK vs. 41.2% no TNK, p=0.04), and in patients transported by helicopter who did not undergo EVT, there was an even higher likelihood of good functional outcome associated with TNK treatment (69.2% TNK vs. 40.1% no TNK, p=0.049). Conclusion: In our cohort, treatment with TNK was associated with improved functional outcomes in helicopter transported patients but not in those transported by ground, and this benefit was found to be even more robust in patients who did not undergo EVT. Future studies are needed to validate these findings and investigate the underlying pathophysiological mechanism.