Abstract Details

Title Failure of Tenecteplase in Maintaining Collateral Circulation in Large Vessel Occlusion Strokes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-007

Objective

Our objective was to investigate early Tenecteplase (TNK) use with the degree of collateralization in subjects with acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO).

Background Administration of Alteplase with collateral patency has been evaluated in AIS patients. Large studies evaluating Alteplase demonstrate an association of successful recanalization and good clinical outcome with ASITN/SIR scale greater than 2. However, there is paucity of data looking at the association between IV TNK and acute collateralization.

Design/Methods Collateralization was assessed on DSA using the ASTIN/SIR scale. Grades were defined as: 0 no collaterals to ischemic region; 1 slow collaterals peripherally; 2 rapid collaterals peripherally; 3 slow collaterals within ischemic region; 4 complete retrograde perfusion to ischemic region. Subjects with LVO undergoing mechanical thrombectomy s/p TNK as part of the early clinical use of TNK within 4.5h were assigned a grade. Mean ASITN/SIR scale was determined. Spearman’s rho was used to measure association of collateral grade with TICI score. Patients with TNK-associated recanalization at the time of DSA were excluded. Social Science Statistics was used for data analysis.

Results From October 2020 to April 2021, 16 subjects (6 females; age, 63.25 95% CI [54.9207, 71.5793]) received TNK and underwent mechanical thrombectomy. From those subjects, 25 % (n=4) had IV TNK-associated recanalization with normalization of collateral blood flow and were excluded. Of the rest, (n=12, 75%) had a mean ASITN/SIR collateral grade of 1.08 (95% CI [0.5762, 1.5838]). Association between collateral grade and final TICI score was not statistically significant (rs = -0.33576, p = 0.28598) suggesting inability of TNK to result in/maintain collateral flow.

Conclusions Poor correlation of collateral grade and TICI score may have implications of faster progression in AIS patients with LVO, receiving TNK, if recanalization is not achieved. Larger prospective studies are needed to evaluate the effect of TNK on collateralization.

Authors/Disclosures
Farah Y. Fourcand, MD (Cleveland Clinic Indian River) PRESENTER	Dr. Fourcand has nothing to disclose.
Nancy Gadallah, DO (JFK Neuroscience Institute at JFK Medical Center)	Dr. Gadallah has nothing to disclose.
Arifa Ghori (Hackensack Meridian Health- JFK Medical Center)	Dr. Ghori has nothing to disclose.
Danisette Torres, MD (Florida Atlantic University)	Dr. Torres has nothing to disclose.
Abdallah O. Amireh, MD (HMH JFK Medical Center)	Dr. Amireh has nothing to disclose.
Haralabos Zacharatos, MD	Dr. Zacharatos has nothing to disclose.
Siddhart K. Mehta, MD	Dr. Mehta has nothing to disclose.
Jawad F. Kirmani, MD	Dr. Kirmani has nothing to disclose.

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