Abstract WP6: Safety Outcomes of Intravenous Tenecteplase in Tandem Occlusions Undergoing Mechanical Thrombectomy With Acute Stenting

Background: Studies have demonstrated that the addition of alteplase for patients with tandem lesions who underwent mechanical thrombectomy and acute stenting was safe with improved outcomes. We aimed to assess the safety and efficacy of Intravenous Tenecteplase (IV TNK) for patients with tandem lesions who undergo mechanical thrombectomy (MT) and acute stenting.

Methods: Using a prospectively collected registry of stroke patients seen at our institution we identified patients who underwent mechanical thrombectomy and acute carotid stenting between January 2021 and May 2023. Primary outcomes included symptomatic intracranial hemorrhage (sICH) and parenchymal hematoma type 2 (PH-2). Secondary outcomes included favorable functional outcome (90-day modified Ranking score 0-2), 90-day mortality, successful reperfusion (modified Thrombolysis in Cerebral Infarction [TICI] score 2b-3) and median number of passes used. Outcomes were adjusted for age, NIHSS, ASPECTS, and last known well (LKW) time to arrival time.

Results: A total of 86 patients were included of which 14 received IV TNK + MT with carotid stenting and 72 MT with carotid stenting alone. Patients who received IV TNK had lower median LKW to arrival time in minutes (133 [IQR 81-193] vs 575 [IQR 313-925], P<0.001), and had higher ASPECTS median score (9 [9-10] vs 8 [7-9], P=0.03). There was 0% sICH vs 13.3% (p=0.36), and 0% PH-2 vs 4.2% (p>0.999) in the IV TNK and the MT alone group, respectively. All patients who received tnk received intraprocedural eptifibatide loading dose and dual antiplatelets within 24 hours. Favorable functional outcomes were seen in 80.0% of IV TNK vs 58.2% of MT with carotid stenting alone (aOR 6.92 [0.45-105.7], p=0.16). Both groups had similar 90-day mortality rates 10% vs 9.1% (aOR 0.59 [0.01-34.9], p=0.8), number of passes 1 [1-2] vs 2 [1-3], (P=0.09), and successful reperfusion (TICI score 2b-3) 100% vs 98.6% (p>0.999).

Conclusion: Our study shows that the combination of IV TNK and MT with acute stenting for tandem lesions did not increase the risk of sICH or PH-2. IV TNK group did not have statistically significant differences in our secondary outcomes as well. However, the sample size was low, and this patient population needs to be studied in a larger group.