Abstract Details

Title Comparison of Hemorrhagic and Non-Hemorrhagic Access-Site Complications with Tenecteplase vs Alteplase Bridging Thrombolysis Prior to Stroke Thrombectomy

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-009

Objective To compare the rates of hemorrhagic and non-hemorrhagic femoral access-site complications between Tenecteplase (TNK) and Alteplase (TPA) bridging thrombolysis in patients undergoing stroke thrombectomy.

Background Access-site complications, particularly with the transfemoral approach, are a known risk in stroke thrombectomy. Bridging thrombolysis may increase the risk for hemorrhagic complications.

Design/Methods We retrospectively reviewed large vessel occlusion stroke (LVOS) patients (>18 years) treated with intravenous thrombolysis (IVT) followed by emergent endovascular treatment (EVT) from January 2020 to May 2024 (n=280). Eleven patients were excluded due to rapid recovery after thrombolysis, negating the need for EVT. Access routes were categorized as transfemoral, transradial, transbrachial, or transcarotid. Complications were grouped into hematomas, pseudoaneurysm, and arterial occlusion. Major complications were defined as those requiring surgical or interventional treatment.

Results Of the 269 patients who underwent IVT and EVT, TPA was administered in 99 (35.4%) and TNK in 181 (64.6%). Access routes were predominantly transfemoral (95.5%), with transradial (3.7%), transbrachial (0.4%), and transcarotid (0.4%) used less frequently. Access-site complications occurred exclusively in the transfemoral group. Hematomas occurred in 22 cases (8.6%), pseudoaneurysms in 4 (1.6%), and arterial occlusions requiring surgical repair in 2 (0.8%). One pseudoaneurysm required thrombin injection (0.4%), while the others were managed conservatively. Hematoma rates were comparable between TPA and TNK groups (p=0.488). Coronary artery disease was the strongest predictor of hematoma occurrence, while platelet count, INR, thrombolytic-administration-to-femoral-puncture time, and arteriotomy closure method were not associated with complications. Antithrombotic use and atrial fibrillation were the strongest predictors of overall access-site complications.

Conclusions Hemorrhagic and non-hemorrhagic access-site complications were low and comparable between TNK and TPA. Coronary artery disease and antithrombotic use were significant predictors of access-site complications, but thrombolytic type did not influence the complication rate. Notably, complications occurred exclusively with transfemoral access.

Authors/Disclosures
Veronica Bohl PRESENTER	Ms. Bohl has nothing to disclose.
Tyler M. Bielinski	Mr. Bielinski has nothing to disclose.
Grant N. Badger	Mr. Badger has nothing to disclose.
Kelsey Kline, BS	Miss Kline has nothing to disclose.
Prateeka Koul, MD	Dr. Koul has nothing to disclose.
Anthony Noto, MD (Geisinger Medical Center)	Dr. Noto has nothing to disclose.
Clemens M. Schirmer, MD, PhD	Dr. Schirmer has received personal compensation for serving as an employee of Geisinger. Dr. Schirmer has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Balt. Dr. Schirmer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic. Dr. Schirmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stryker. Dr. Schirmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viz.ai. Dr. Schirmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Microvention. Dr. Schirmer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Werfen. Dr. Schirmer has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Schirmer has stock in NTI. Dr. Schirmer has stock in REIST. The institution of Dr. Schirmer has received research support from NIH. The institution of Dr. Schirmer has received research support from Medtronic. The institution of Dr. Schirmer has received research support from Cerenovus. The institution of Dr. Schirmer has received research support from MIVI. The institution of Dr. Schirmer has received research support from Balt. The institution of Dr. Schirmer has received research support from Microvention. The institution of Dr. Schirmer has received research support from Stryker. The institution of Dr. Schirmer has received research support from Penumbra. The institution of Dr. Schirmer has received research support from NICO. The institution of Dr. Schirmer has received research support from Route 92.
Philipp Hendrix, MD, PhD	Dr. Hendrix has nothing to disclose.

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