ABSTRACT NUMBER: ESOC2026A1511 HYPERACUTE OUTCOMES OF INTRAVENOUS THROMBOLYSIS: RTPA VERSUS TENECTEPLASE (TNK)

Abstract Background and aims Intravenous thrombolysis (IT) remains a cornerstone of acute ischemic stroke (AIS) management. Tenecteplase (TNK) has emerged as an alternative to recombinant tissue plasminogen activator (rTPA); however, real-world comparative data on hyperacute clinical outcomes remain limited. We aimed to compare efficacy and safety of rTPA and TNK in patients with AIS treated ≤4.5 hours of symptom onset. Methods Retrospective observational study including patients with AIS treated with IT between January 2024 and December 2025. Primary efficacy outcomes included National Institutes of Health Stroke Scale (NIHSS) scores at 24 hours and at discharge, early neurological improvement (ENI; decrease of ≥8 NIHSS points at 24 hours), and averted recanalization prior to mechanical thrombectomy. Primary safety outcomes were symptomatic intracerebral hemorrhage (sICH) and in-hospital mortality. Results 92 patients were included (mean age 78 ± 13 years; 52.2% female), of whom 44 (47.8%) received rTPA and 48 (52.2%) TNK. Baseline demographic and clinical characteristics were comparable between groups. Workflow metrics favored TNK, with significantly shorter median door-to-imaging time, door-to-needle time and door-to-groin time. There were no significant differences in NIHSS scores at 24 hours or discharge, ENI rates, or averted recanalization. However, sICH occurred more frequently in the TNK group (14.6% vs. 0%, p < 0.05). Conclusions In this real-world cohort, TNK was associated with faster in-hospital workflow times compared with rTPA, with similar functional outcomes. The higher rate of sICH observed with TNK highlights the need for further prospective studies to better define its safety profile. Conflict of interest nothing to disclose Figure 1 - belongs to Results