Abstract DP027: Alteplase to Tenecteplase: Large Vessel Occlusion Outcomes at a Single Comprehensive Stroke Center

Authors: Cory Tremain, MSN, RN, SCRN, Penelope McCabe, BSN, RN, SCRN, Lauren E. Fournier, MD Introduction: In patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO), there is mixed data on thrombectomy outcomes with the administration of tenecteplase (TNK) as compared to alteplase (tPA). This study sought to evaluate whether TNK may achieve higher TICI score reperfusion rates and improved functional outcomes compared with tPA, in patients with LVO, who are eligible for mechanical endovascular reperfusion (MER) therapy. On April 1, 2025, our single comprehensive stroke center adopted TNK as the primary thrombolytic for patients age 14 and older with AIS replacing tPA. Methods: AIS patient data was prospectively collected from December 2024 to July 2025. All patients with LVO who met facility thrombectomy criteria in the timeframe were screened. Patients who did not receive thrombolysis were excluded. Patients were divided into two cohorts: tPA group December 2024 to March 2025 and TNK group April 2025 to July 2025. Data collected included whether MER was completed or aborted due to neurologic improvement before groin puncture and the TICI reperfusion scores post-thrombectomy in both groups. Fisher’s exact test was used to analyze data. Results: There were 20 patients with LVO pre-TNK transition and 30 post-TNK. Among those, 14 without thrombolysis were excluded pre-TNK and 18 post-TNK. In the TNK group, 67% (8 of 12) of potential MER cases were aborted before groin puncture due to neurological improvement compared to 0 out of 6 in the tPA group (p=0.13). TNK was associated with increased likelihood of greater than TICI 2b outcome [92% (11 of 12) in TNK group vs 50% (3 of 6) in tPA group, p=0.08]. Conclusions: This study suggests a trend toward more favorable reperfusion in AIS patients with LVO who receive TNK and undergo MER than in those that receive tPA. A higher proportion of patients had aborted MER due to neurological improvement prior to groin puncture in the TNK population than the tPA group, although not statistically significant. Further studies are warranted with larger sample sizes to understand the benefit of TNK over tPA in patients with LVO.