Abstract Details

Title Thrombolysis with Tenecteplase Compared to Alteplase Among Diabetic and Non-Diabetic Patients Undergoing Endovascular Thrombectomy: Is There Any Difference?

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-028

Objective To compare the clinical efficacy of Alteplase (ALT) and Tenecteplase (TNK) in diabetic and non-diabetic patients undergoing endovascular therapy (EVT).

Background

Stroke patients with large vessel occlusions (LVO) anecdotally have better outcomes when treated with TNK. Diabetes mellitus (DM) is an adverse risk factor determining clinical outcomes among LVO patients undergoing EVT.

Design/Methods This is a retrospective study of patients undergoing EVT after intravenous thrombolysis (IVT). The biomarkers neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) were used to assess systemic inflammation (SIRS). Mean platelet volume-to-platelet count ratio (MPV:PLT) was used to assess procoagulant response. Non-parametric tests were performed to compare IVT in DM and non-diabetic cohorts. Clinical outcomes were assessed by modified Rankin scale (mRS) at 3-months.

Results 109 patients [40 with DM (20 ALT, 20 TNK) and 69 non-diabetic (35 ALT, 34 TNK)] underwent EVT after IVT. TNK use for IVT, preceding EVT, showed higher rise in NLR [DM+ALT vs. DM+TNK: 104.6% (IQR: 42.3%, 339.6%) vs. 152.1% (77.5%, 507.1%), p=.352; Non-DM+ALT vs. Non-DM+TNK: 142.6% (58.7%, 272.1%) vs. 392.9% (156.6%, 699.6%), p=.003] and SII [DM+ALT vs. DM+TNK: 83.5% (16.6%, 339.9%) vs. 166.3% (58.5%, 579.9%), p=.379; Non-DM+ALT vs. Non-DM+TNK: 128.2% (46.0%, 225.0%) vs. 322.2% (173.3%, 433.6%), p=.001] post-procedure. However, rise in MPV:PLT was significantly less among non-diabetics treated with TNK [ALT vs. TNK: 22.7% (3.1%, 43.2%) vs. 5.4% (0.2%, 16.9%), p=.008]. DM patients treated with TNK had a better 3-month mRS of 0-2 than those treated with ALT (52.6% vs 17.6%, p=.029). However, 3-month mRS was similar among non-diabetics undergoing EVT (ALT vs. TNK: 33.3% vs. 43.8%, p=.388).

Conclusions Despite similar SIRS in TNK-treated DM patients, they had a more favorable 3-month mRS compared to ALT. In contrast, despite less procoagulant response among TNK-treated non-diabetic patients, a higher SIRS resulted in similar 3-month mRS, alluding to a deleterious effect of SIRS in this cohort.

Authors/Disclosures
Sheetal Hegde, MD (University of Texas Southwestern Medical School) PRESENTER	Dr. Hegde has nothing to disclose.
Roberto Hernandez	Roberto Hernandez has nothing to disclose.
Amber Salter, PhD (UT Southwestern Medical Center)	Dr. Salter has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gryphon Bio. Dr. Salter has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abata Therapeutics. Dr. Salter has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sora Neuroscience. Dr. Salter has stock in Owl Therapeutics. The institution of Dr. Salter has received research support from National Multiple Sclerosis Society. The institution of Dr. Salter has received research support from Department of Defense Congressionally Directed Medical Research Program. The institution of Dr. Salter has received research support from Consortium of Multiple Sclerosis Centers.
Bappaditya Ray, MD (UT Southwestern Medical Center)	Dr. Ray has nothing to disclose.

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