Abstract Details

Title Intravenous Thrombolysis with Tenecteplase Versus Alteplase in Acute Ischemic Stroke Tandem Lesions: a Systematic Review and Meta-Analysis of Current Available Literature

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P12 - Poster Session 12 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-009

Objective To synthesize available data comparing the efficacy and safety profiles of alteplase and tenecteplase in patients with tandem occlusions.

Background Tandem infarct is characterized by simultaneous extracranial and ipsilateral intracranial arterial occlusions. Currently, treatment involves intravenous thrombolysis (IVT) followed by endovascular thrombectomy. Direct comparisons between Alteplase and Tenecteplase for IVT in patients with tandem occlusions remain limited.

Design/Methods We systematically searched PubMed, Embase and Cochrane from inception to June 2024 for studies enrolling patients with tandem lesions in acute ischemic stroke treated with IVT involving Tenecteplase or Alteplase. Outcomes of interest included (1) modified Rankin Scale (mRS) 0-1, (2) mRS 0-2, (4) successful recanalization (TICI 2b-3), (4) symptomatic intracranial hemorrhage (sICH), and (5) overall mortality. We compared results using Risk Ratio (RR) with 95% Confidence Intervals (CI).

Results Three studies published between 2023 and 2024 were included: two randomized controlled trials and one observational study, comprising 917 patients. Tenecteplase was administered to 230 (25,1%) patients. Age ranged from 57 to 82 years, with baseline NIHSS from 10 to 24 points, and there were 314 (34.2%) female patients. No statistically significant difference between groups were observed for mRS 0-1 (RR 0.80; 95% CI 0.35-1.83; p = 0.597; I² = 86%), mRS 0-2 (RR 1.04; 95% CI 0.88-1.23; p = 0.630; I² = 0%), TICI 2b-3 (RR 1.00; 95% CI 0.93-1.09; p = 0.909; I² = 0%), sICH (RR 1.09; 95% CI 0.64-1.84; p = 0.756; I² = 0%), and overall mortality (RR 0.68; 95% CI 0.45-1.05; p = 0.081; I² = 17%).

Conclusions This meta-analysis found that tenecteplase achieved similar outcomes to alteplase in improving functional outcomes and recanalization rates. No significant difference was noted between tenecteplase and alteplase in sICH and mortality rates. Further large-scale randomized studies are needed to provide a definitive conclusion on the comparative efficacy and safety of tenecteplase versus alteplase.

Authors/Disclosures
Ocilio R. Goncalves, MS PRESENTER	Mr. Goncalves has nothing to disclose.
Anthony Hong, MD	Dr. Hong has nothing to disclose.
Ana Santos, MD	Ms. Santos has nothing to disclose.
Marcio Y. Ferreira, MD	Dr. Ferreira has nothing to disclose.
Gabriel d. Monteiro	Mr. Monteiro has nothing to disclose.
Victor G. Soares, MS	Mr. Soares has nothing to disclose.
Luiza G. Schmitt	No disclosure on file
Savio Batista, MD (Emory University)	Mr. Batista has nothing to disclose.
Luis O. Nogueira, medical student	Mr. NOGUEIRA has nothing to disclose.
Christian K. Fukunaga, MS (Medical Student)	Mr. Fukunaga has nothing to disclose.
Marina Vilardo	Miss Vilardo has nothing to disclose.
João Victor Araújo de Oliveira, MD	Mr. Araújo de Oliveira has nothing to disclose.
João de Deus Costa Alves (FMABC University Center)	No disclosure on file
Kelson J. Almeida, PhD	Prof. Almeida has nothing to disclose.

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