Angioedema as anaphylactic reaction following tenecteplase administration in acute ischemic stroke: A case report

Background: Tenecteplase (TNK) is a novel thrombolytic agent with improved fibrin specificity and longer half-life than alteplase. It is increasingly being adopted worldwide for the treatment of acute ischemic stroke (AIS). Although well tolerated, rare adverse reactions can occur, such as angioedema, which can rapidly progress and potentially cause airway compromise. Case Description: We report a 60-year-old female presenting to the neurology emergency department with acute right-sided hemiplegia and motor aphasia who received intravenous TNK approximately 2 h after symptom onset. Shortly after admission, she developed progressive oropharyngeal angioedema accompanied by urticaria and inspiratory stridor. Given the risk of impending airway obstruction, she required urgent airway management with endotracheal intubation and initiation of mechanical ventilation. After stabilization, she underwent subsequent mechanical thrombectomy and carotid stenting, which were successful. Conclusion: Early recognition of thrombolytic-associated angioedema and immediate involvement of a multidisciplinary team are critical for airway protection and continuation of reperfusion therapies, helping to optimize clinical outcomes in AIS.