Abstract Details

Title Final Cerebral Infarct Volume in Acute Ischemic Stroke – Is It Different Among Diabetics Treated with Tenecteplase vs. Alteplase?

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-004

Objective To compare final cerebral infarct volumes (FIV) among diabetic and non-diabetic patients treated with Alteplase (TPA) or Tenecteplase (TNK) and determine whether either thrombolytic agent is associated with better clinical outcome.

Background Diabetes mellitus (DM) and larger FIV are known determinants of poor clinical outcomes in acute ischemic stroke (AIS). Our preliminary study reported improved clinical outcome among DM patients treated with TNK, but it is unknown whether TNK treatment results in smaller FIV.

Design/Methods Retrospective analysis of AIS patients with premorbid modified Rankin score (mRS) of 0-2 and treated with TPA or TNK over a 5-year period. FIV was measured on 24-h post-intervention CT/MRI using image segmentation. A mRS of 0-2 and 3-6 at 3 months was regarded as favorable and unfavorable outcomes, respectively. Intra-group analysis was performed using univariate tests, while inter-group analysis was conducted via multivariable regression.

Results Two hundred and ninety-two patients met the inclusion criteria (DM: n=97, non-DM: n=195). Among DM patients, there was over a two-fold odds of achieving 3-month favorable outcome with TNK compared to TPA was (odds ratio (OR [95% CI]): 2.39 [1.04, 5.50], p=0.043]. In non-DM patients, the OR was 2.18 [95% CI (1.20, 3.96), p=0.011]. The median FIV in the entire cohort was 11.9 (IQR: 1.6-59.4), with 20.0 (IQR: 1.4-73.0) for diabetic and 10.0 (IQR: 2.0-50.0) for non-diabetic patients (p=0.522). There was a strong positive correlation between FIV and 3-month mRS (Pearson r=0.600, p<0.001). In a multivariable model adjusting for treatment, presence of DM was associated with an 88% increased odds of unfavorable outcome and every 1 mL increase in FIV associated with 4% increased odds (p<0.001).

Conclusions Smaller FIV and thrombolysis using TNK were associated with favorable 3-month mRS in both diabetic and non-diabetic patients. This suggests a pharmacological superiority of TNK compared to TPA.

Authors/Disclosures
Bappaditya Ray, MD (UT Southwestern Medical Center) PRESENTER	Dr. Ray has nothing to disclose.
Afza Mohammed	Miss Mohammed has nothing to disclose.
Sheetal Hegde, MD (University of Texas Southwestern Medical School)	Dr. Hegde has nothing to disclose.
Roberto Hernandez	Roberto Hernandez has nothing to disclose.
Amber Salter, PhD (UT Southwestern Medical Center)	Dr. Salter has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gryphon Bio. Dr. Salter has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abata Therapeutics. Dr. Salter has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sora Neuroscience. Dr. Salter has stock in Owl Therapeutics. The institution of Dr. Salter has received research support from National Multiple Sclerosis Society. The institution of Dr. Salter has received research support from Department of Defense Congressionally Directed Medical Research Program. The institution of Dr. Salter has received research support from Consortium of Multiple Sclerosis Centers.

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