Abstract Details

Title Intracranial and Extracranial Systemic Complications with Alteplase vs Tenecteplase among Large Vessel Occlusion Stroke Patients Undergoing Thrombectomy

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (5:00 PM-6:00 PM)

Poster/Presentation
Number 13-013

Objective To compare rates of intracranial hemorrhages (ICH) and extracranial systemic complications between Tenecteplase (TNK) and Alteplase (TPA) in large vessel occlusion stroke (LVOS) patients referred for thrombectomy.

Background Adverse events following intravenous thrombolysis (IVT) include ICH, extracranial bleeding complications, and systemic complications such as angioedema.

Design/Methods We conducted a retrospective review of acute ischemic stroke patients (>18 years) treated with IVT and emergent endovascular treatment (EVT) between January 2020 and May 2024 (n=280). Patients were divided into two cohorts based on thrombolytic agent received: TNK (n=181) or TPA (n=99). Intracranial hemorrhage was classified according to the Heidelberg Bleeding Classification. Rates of any ICH, parenchymal hematomas types 1 and 2 (PH type 1 and 2), subarachnoid hemorrhage (SAH), and symptomatic ICH (sICH) were assessed. Systemic complications included access-site hematomas, retroperitoneal hematoma, gastrointestinal bleeding, and angioedema. Comparative statistical analyses were performed to evaluate complication rates across the two thrombolytic groups.

Results Of the 280 patients, 181 (64.6%) received TNK and 99 (35.4%) received TPA. Any ICH was observed in 43.4% of TPA and 38.9% of TNK cases (p=0.524). PH type 1 and 2 occurred in 13.1% of TPA and 12.8% of TNK cases (p=1.000). SAH was noted in 6.1% of TPA and 7.2% of TNK cases (p=0.808). sICH occurred in 2.0% of TPA and 2.8% of TNK patients (p=1.000). Multivariable analysis showed no significant association between thrombolytic type and occurrence of any ICH, PH, SAH, or sICH. Access-site hematomas were comparable between TNK (9.8%) and TPA (6.4%) (p=0.343). No retroperitoneal hematoma or gastrointestinal bleeding was reported. Angioedema was observed in 2.0% of TPA and 1.1% of TNK patients (p=0.616).

Conclusions The rates of intracranial hemorrhage and systemic complications were comparable between TNK and TPA groups. Therefore, TPA and TNK appear to have similar safety profiles in LVOS patients undergoing EVT.

Authors/Disclosures
Veronica Bohl PRESENTER	Ms. Bohl has nothing to disclose.
Tyler M. Bielinski	Mr. Bielinski has nothing to disclose.
Kelsey Kline, BS	Miss Kline has nothing to disclose.
Grant N. Badger	Mr. Badger 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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