ABSTRACT NUMBER: ESOC2026A1223 EARLY NEUROLOGICAL OUTCOMES AND SAFETY OF INTRA-ARTERIAL TENECTEPLASE IN MEDIUM AND DISTAL VESSEL OCCLUSIONS: A SINGLE-CENTER EXPERIENCE

Abstract Background and aims In a single-center study, we evaluated the efficacy and safety of using intra-arterial Tenecteplase (IA-TNK) for treating medium and distal vessel occlusions in patients with ischemic stroke. Methods We reviewed patients treated from January 2024 to October 2025. We administered a maximum dose of 10 mg of IA-TNK in 2.5mg increments via super-selective catheterization. CT perfusion studies graded angiographic evidence of perfusion. Neurological examinations were performed before, 24 hours, and 7 days post-treatment. Functional outcomes were evaluated using the modified Rankin scale (mRS) at 30 days post-treatment. Results Ten patients received IA-TNK (median age, 68 years). The baseline National Institutes of Health Stroke Scale scores (NIHSS) ranged from 5 to 18, and the baseline Alberta Stroke Program Early CT Score ranged from 8 to 10. Four patients received adjunctive intravenous thrombolysis and/or carotid stenting. Early neurological improvement (ENI), defined as a decrease of four or more points in NIHSS, occurred in 70% of patients within 24 hours and in 90% by 7 days, with no intracranial hemorrhage. CT perfusion revealed a reduction in Tmax >6s median volume from 52.5 mL to 17 mL. At 30 days, functional independence, defined as an mRS score of 0–2, was achieved in seven patients, and an mRS score of 3 was achieved in one patient. Two patients had mRS scores of 5 or 6 because of terminal malignancy. Conclusions In our experience, IA-TNK in doses up to 10mg, with or without adjunctive therapies, appeared safe and was associated with early neurological improvement. Conflict of interest Syed Gillani: nothing to disclose/ Hatem Tolba: nothing to disclose/ Sinan Tatli:nothing to disclose/ Ahmed Hassan: nothing to disclose/ Balint Otvos: nothing to disclose/ Farhan Siddiq: nothing to disclose/ Camilo Gomez: nothing to disclose/ Adnan Qureshi: nothing to disclose.