Abstract Details

Title Real-World Bridging with Intra-arterial therapy is safe after Tenectplase in patients with Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

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

Poster/Presentation
Number 13-009

Objective

Our objective was to evaluate the incidence of hemorrhagic transformation in subjects who received TNK followed by IAT outside of clinical trial setting.

Background The safety profile of IV Tenecteplase (TNK) as a bridging therapy to Intra-arterial therapy (IAT) is not well-established in patients receiving acute ischemic stroke therapy.

Design/Methods Electronic medical records of subjects with stroke secondary to LVO who received TNK and IAT within 4.5h of last known normal were reviewed. CT head within 24 hours post-TNK was evaluated for hemorrhagic transformation (HT). Severity was determined by ECASS III criteria Symptomatic intracranial hemorrhage was defined as an increase in NIHSS greater than or equal to 4. Clinical outcomes were assessed with NIHSS at admission, discharge and mRS scores at one month. Z score population proportions were used for subgroup analysis. Social Science Statistics was used for data analysis.

Results From October 2020 to April 2021, 20 subjects received IV Tenecteplase. Four subjects did not have LVO or undergo IAT and were excluded. Four subjects (25%) developed hemorrhagic transformation. Of this subset, 2 subjects (12.5%) had asymptomatic HI-1, 1 subject had symptomatic HI-2, and 1 subject had asymptomatic PH-1. One subject developed intracranial hemorrhage (ICH score 5) outside of stroke region (intraventricular, subarachnoid, infratentorial parenchymal) without evidence of hemorrhagic transformation of ischemic stroke. In subgroup analysis between subjects with HT and without HT, there was no statistically significant difference in intra-arterial non-thrombolytics (z=0.1393, p=0.44433); there was a trend towards significance in number of passes (z=1.2534, p=.10565) and periprocedural IV heparin use for intracranial stenting and/or angioplasty (z=0.9342, p=0.17619). There was a statistically significant increase of HT when periprocedural IV integrilin (z=1.6727, p=0.04746) was used.

Conclusions Our small subset of early real-world experience demonstrates a higher rate of symptomatic transformation in bridging with TNK, when compared with Alteplase. Larger prospective studies are needed.

Authors/Disclosures
Farah Y. Fourcand, MD (Cleveland Clinic Indian River) PRESENTER	Dr. Fourcand has nothing to disclose.
Sindhu Sahito, MD (JFK Medical Center)	Dr. Sahito has nothing to disclose.
Hemal Patel, MD (Northshore University Hospital, Northwell Health)	Dr. Patel has nothing to disclose.
Nasar Ali, DO (Neuroscience Center)	Dr. Ali has nothing to disclose.
Teye A. Umanah, MD (St Thomas Elgin General Hospital)	Dr. Umanah has nothing to disclose.
Siddhart K. Mehta, MD	Dr. Mehta has nothing to disclose.
Haralabos Zacharatos, MD	Dr. Zacharatos has nothing to disclose.
Spozhmy Panezai, MD (JFK Medical Center)	Dr. Panezai has nothing to disclose.
Jawad F. Kirmani, MD	Dr. Kirmani has nothing to disclose.
	No disclosure on file

��ɫ��

��ɫ��