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Abstract Details

Acute Ischemic Stroke in the Third Trimester of Pregnancy: A Case of Treatment with Tenecteplase and Thrombectomy
Cerebrovascular Disease and Interventional Neurology
P6 - Poster Session 6 (5:00 PM-6:00 PM)
5-015

To describe a rare case of acute ischemic stroke (AIS) during the third trimester of pregnancy successfully treated with tenecteplase (TNK) followed by mechanical thrombectomy. 

  

AIS in pregnancy is uncommon, occurring in roughly 30 per 100,000 pregnancies. While thrombolytic therapy and mechanical thrombectomy are established standards of care in non-pregnant patients presenting within the therapeutic window, their use in pregnancy remains controversial. This uncertainty stems from limited available data and the lack of formalized treatment guidelines for this unique population.
A 40-year-old woman at 35 weeks gestation, with no prior medical or obstetric complications, presented with a sudden-onset headache, word-finding difficulty, and expressive aphasia that began at 11:15 AM. On arrival, her blood pressure was 188/85 mmHg. Neurological examination showed preserved strength and cranial nerve function, with isolated expressive aphasia. Non-contrast CT showed no hemorrhage. CT angiography revealed a proximal left middle cerebral artery (M2) occlusion, and CT perfusion confirmed a left frontoparietotemporal penumbra. Following multidisciplinary discussion among neurology, neurointerventional, and obstetric teams, and after shared decision-making with the patient and her spouse, intravenous TNK was administered. Blood pressure was controlled with labetalol and nicardipine, followed by successful mechanical thrombectomy without complications. 
The patient showed rapid improvement in language function following intervention and experienced no maternal, obstetric, or fetal complications. She was transitioned to inpatient monitoring, remained stable throughout hospitalization, and was later discharged in good condition.  
This case highlights the feasibility and safety of combining TNK with mechanical thrombectomy for the treatment of AIS in late pregnancy. The coordinated multidisciplinary approach allowed for rapid decision-making and favorable outcomes for both mother and fetus. As TNK continues to gain clinical adoption, additional case data are essential to inform evidence-based guidelines for stroke management during pregnancy.  
Authors/Disclosures
Amanda Kettman
PRESENTER 		Mrs. Kettman has nothing to disclose.
Julia Kaufmann Ms. Kaufmann has nothing to disclose.
Tiffany Dang Mrs. Dang has nothing to disclose.