Effect of adjunctive intra-arterial tenecteplase on infarct volume in acute ischemic stroke patients undergoing thrombectomy

Background: Adjunct intra-arterial (IA) tenecteplase (TNK) may improve microvascular patency postthrombectomy in acute ischemic stroke (AIS) patients. We determined the effect of IA-TNK on infarct volume in large vessel occlusion (LVO) AIS. Methods: We analyzed the clinical data of AIS-LVO patients who received IA-TNK after endovascular thrombectomy (EVT) and EVT alone. Infarct volume on postintervention magnetic resonance imaging (MRI) (24–48 h postprocedure) was calculated using 3D Slicer software. We compared infarct volumes between the groups using one-way analysis of variance, and Pearson correlation assessed the relationship between infarct volume and last known modified Rankin scale (mRS). Statistical analysis was performed using R (version 4.1.2). Results: A total of 56 patients with LVO-AIS who underwent EVT were included; 14 patients received adjunctive IA-TNK and 42 received EVT alone. Postprocedure, the proportion of patients who achieved thrombolysis in cerebral infarction ≥2b was 100% versus 88.0% in patients who received adjunctive IA-TNK and those who received EVT alone. The mean (±standard error) infarct volume on postintervention MRI was significantly smaller in those who received IA-TNK (33.0 ± 9.2 cm 3 vs. 58.8 ± 10.1 cm 3 , P = 0.06). The median (interquartile range) last known mRS was 2.5 (1–4) versus 3.0 (2–6) with 50% versus 35.7% achieved mRS 0–2 in patients who IA TNK and those who received EVT alone. A significant correlation was found between infarct volume and last known mRS in the overall cohort. Conclusion: Adjunctive IA-TNK with EVT in LVO-AIS patients resulted in smaller postintervention infarct volumes compared to EVT alone.