Abstract Details

Title Intravenous Thrombolysis for Acute Ischemic Stroke on Anti-amyloid Immunotherapy Donanemab

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 4-005

Objective Due to case reports of fatal multifocal hemorrhage after thrombolysis in patients on amyloid immunotherapy, a scientific advisor from the American Heart Association recommends against the use of thrombolytic therapy. We report a stroke patient on anti-amyloid immunotherapy with a favorable clinical outcome.

Background NA

Design/Methods A 79-year old female with a history of Alzheimer’s dementia (APOE E3/4) on anti-amyloid infusion, hyperlipidemia, hypertension, and prior TIA on aspirin presented for acute ischemic stroke. She had received the first infusion of the anti-amyloid donanemab 35 days prior to stroke presentation, with an MRI brain 21 days prior that was negative for Amyloid-Related Imaging Abnormalities (ARIA), including Susceptibility-Weighted Imaging. She received the 2nd infusion 7 days prior. On day of stroke presentation, she developed left hemiparesis and was transported to an outside hospital emergency room (ER). Initial National Institutes of Health Stroke Scale (NIHSS) was 15 for left hemiparesis, neglect, visual field defect, and dysarthria. BP was 129/67 mmHg. CT brain was negative for acute changes. CT angiogram head/neck was negative for vessel occlusion. CT perfusion brain showed right middle cerebral artery (MCA) mismatch (Figure 1). She was administered IV tenecteplase (TNK) at 57 minutes from last known well. Her husband arrived to the ER after TNK was already given and reported donanemab use at that time. The patient had rapid neurological improvement and 1 hour post TNK, NIHSS was 0. MRI brain on post-stroke day 1 showed a right MCA branch infarct without hemorrhage (Figure 2). On 3-month follow-up, NIHSS was 0 and modified Rankin Scale was 1.

Results NA

Conclusions The recommendation to withhold thrombolytic therapy in patients on anti-amyloid immunotherapy due to concern of ARIA and hemorrhage is based upon isolated case reports. Further investigation is warranted to better understand and identify patients who may be at lower risk of hemorrhagic complications.

Authors/Disclosures
Lin Abigail Tan PRESENTER	Miss Tan has nothing to disclose.
Vivien H. Lee, MD, FAAN (OSU Comprehensive Neurovascular Center)	Dr. Lee has nothing to disclose.
Douglas W. Scharre, MD, FAAN (Ohio State University)	Dr. Scharre has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for BrainTest, Inc. Dr. Scharre has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Otsuka. Dr. Scharre has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Scharre has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Scharre has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Eisai. Dr. Scharre has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Eli Lilly. The institution of Dr. Scharre has received research support from InSightec. The institution of Dr. Scharre has received research support from Alzheimer's Therapeutic Research Institute (ATRI). The institution of Dr. Scharre has received research support from Eisai. The institution of Dr. Scharre has received research support from vTv Therapeutics. The institution of Dr. Scharre has received research support from National Institute of Health. The institution of Dr. Scharre has received research support from Eli Lilly. The institution of Dr. Scharre has received research support from Biogen. The institution of Dr. Scharre has received research support from Roche. The institution of Dr. Scharre has received research support from Percision Medicine. The institution of Dr. Scharre has received research support from Premier Research Group. The institution of Dr. Scharre has received research support from Genetch. The institution of Dr. Scharre has received research support from Avanir. The institution of Dr. Scharre has received research support from Cerevel Therapeutics. The institution of Dr. Scharre has received research support from Janssen. The institution of Dr. Scharre has received research support from Cassava. The institution of Dr. Scharre has received research support from UniQure. The institution of Dr. Scharre has received research support from Cognition Therapeutics. The institution of Dr. Scharre has received research support from Cognitive Research Corporation. The institution of Dr. Scharre has received research support from EIP. The institution of Dr. Scharre has received research support from Cognito. Dr. Scharre has received intellectual property interests from a discovery or technology relating to health care. Dr. Scharre has received intellectual property interests from a discovery or technology relating to health care.
Cassandra Forrest (Wexner medical Center)	Cassandra Forrest has nothing to disclose.

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