Abstract Details

Title Tenecteplase versus Alteplase Time-to-Treatment Metrics in Large Vessel Occlusion Stroke: A Comparative Analysis from a U.S. Healthcare System

Topic Cerebrovascular Disease and Interventional Neurology

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

Poster/Presentation
Number 13-015

Objective To compare large vessel occlusion stroke (LVOS) time-to-treatment metrics between patients receiving thrombolysis with alteplase (TPA) and tenecteplase (TNK) prior to endovascular treatment (EVT).

Background Tenecteplase has been adopted by many centers across the United States as an alternative to alteplase. Limited data exist comparing the time-to-treatment metrics between these agents in LVOS patients.

Design/Methods Consecutive LVOS patients who received intravenous thrombolysis (either TPA or TNK) and EVT 01/2020 to 05/2024 were reviewed. The stroke system transition from TPA to TNK as primary thrombolytic in May 2021. Patients were stratified based on whether they presented to a comprehensive stroke center (CSC) or a primary stroke center (PSC). Door-to-needle time (DTN) and needle-to-groin puncture time (NTGP) were compared between TNK and TPA groups. A multivariable analysis was performed to identify factors associated with shorter DTN.

Results Of the 280 patients, 123 (43.9%) presented to a CSC, with 74.0% receiving TNK and 26.0% receiving TPA. Among the 157 (56.1%) patients presenting to a PSC, 57.3% received TNK and 42.7% received TPA. At CSCs, DTN was 32 minutes (IQR 25-54) for TNK and 39 minutes (IQR 29-50) for TPA (p = 0.225), while NTGP was 51 minutes (IQR 41-68) for TNK and 50 minutes (IQR 34-70) for TPA (p = 0.627). At PSCs, DTN were 50 minutes (IQR 33-65) for TNK and 44 minutes (IQR 33-60) for TPA (p = 0.476), with NTGP (including transfer) of 126 minutes (IQR 98-160) for TNK and 113 minutes (IQR 88-155) for TPA (p = 0.268). Multivariable analysis identified presentation to CSC and lower INR as independent factors associated with shorter DTN.

Conclusions The transition from TPA to TNK did not significantly improve time-to-treatment metrics, suggesting that workflows with both agents were optimized. Efforts to improve DTNs at PSCs may enhance outcomes of stroke patients.

Authors/Disclosures
Kelsey Kline, BS PRESENTER	Miss Kline has nothing to disclose.
Tyler M. Bielinski	Mr. Bielinski has nothing to disclose.
Veronica Bohl	Ms. Bohl has nothing to disclose.
Grant N. Badger	Mr. Badger has nothing to disclose.
Lisa A. Wasko, RN	Mrs. Wasko has nothing to disclose.
Samantha Doucoure, RN	Mrs. Doucoure 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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