Abstract Details

Title Tenecteplase for Acute Ischemic Stroke in a Left Ventricular Assist Device Patient: A Case Report and Protocol Framework

Topic Cerebrovascular Disease and Interventional Neurology

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

Poster/Presentation
Number 5-001

Objective

To describe the first reported case of tenecteplase (TNK) use for acute ischemic stroke (AIS) in a patient with a continuous-flow left ventricular assist device (CF-LVAD), guided by a predefined institutional protocol.

Background

CF-LVADs carry a high risk of thromboembolic stroke due to altered hemodynamics and prothrombotic physiology. Systemic thrombolysis is rarely pursued in this population because of elevated bleeding risk from the aforementioned physiologic changes and therapeutic anticoagulation, and current guidelines do not provide LVAD-specific recommendations. To our knowledge, TNK use has not been reported for AIS in an LVAD recipient.

Design/Methods

Case report of a 56-year-old man with left ventricular noncompaction (LVNC), American College of Cardiology (ACC) stage D heart failure status post HeartMate 3 CF-LVAD (implanted 3 months prior), prior left ventricular thrombus, atrial flutter, patent foramen ovale, and remote right middle cerebral artery (MCA) infarct without residual deficits presented 3.5 hours after sudden onset left hemiparesis and dysarthria (NIHSS 6). Neuroimaging included CT angiography (no large-vessel occlusion) and CT perfusion (right temporal area mismatch). INR was 1.2 while on warfarin (goal 2.0-3.0). Following multidisciplinary evaluation, TNK 0.25 mg/kg was administered per institutional protocol. Post-thrombolysis blood pressure was managed with invasive monitoring, targeting mean arterial pressure 70–90 mmHg.

Results The patient experienced rapid improvement, achieving NIHSS 0 at discharge. No hemorrhagic complications or LVAD dysfunction occurred during hospitalization.

Conclusions This case illustrates the complexity of AIS management in CF-LVAD patients, where anticoagulation and unique hemodynamics pose challenges for reperfusion therapy. TNK may offer advantages over alteplase, including single bolus dosing, increased fibrin specificity, and operational simplicity. To our knowledge, this is the first reported case of successful TNK use for AIS in a CF-LVAD recipient, demonstrating feasibility within a protocol-driven, multidisciplinary framework. Broader adoption requires further prospective data to define safety, selection criteria, and comparative efficacy versus alteplase and mechanical thrombectomy.

Authors/Disclosures
Dawn W. Ullmann, MD (WALTER REED NATIONAL MILITARY MEDICAL CENTER) PRESENTER	Dr. Ullmann has nothing to disclose.
Andrew J. Ullmann, Jr., DO	Dr. Ullmann has nothing to disclose.
Amie W. Hsia, MD (MedStar Health / MedStar Washington Hospital Center)	The institution of Dr. Hsia has received research support from NIH/NINDS.
Sana Somani, MD, MBBS (Medstar Washington Hospital Center)	Dr. Somani has nothing to disclose.

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