Tenecteplase Averting Mechanical Thrombectomy in Emergent Large Vessel Occlusion

Abstract

Introduction: Tenecteplase has recently been studied as an alternative thrombolytic agent in acute stroke, with a possible superior effect in achieving reperfusion of large intracranial vessels. Case Report: A 90-year-old female patient was admitted to our stroke unit because of acute onset of dysarthria, left-sided neglect, and hemiparesis. Brain computed tomography (CT) coupled with CT angiography and CT perfusion (postprocessed with the use of RAPID software) demonstrated right proximal middle cerebral artery occlusion with a large penumbra/small ischemic core pattern. The patient was subsequently treated with bolus tenecteplase infusion (0.25 mg/kg). Mechanical thrombectomy was abandoned because the patient has rapidly improved. The patient was discharged to her own home 4 days later with no neurological deficit and functionally independent (modified Rankin scale of 0). Conclusion: This case exemplifies the potential of tenecteplase in achieving swift reperfusion in patients with large vessel occlusion associated with a substantial mismatch penumbral pattern.

Acute reperfusion therapies for acute ischemic stroke patients with unknown time of symptom onset or in extended time windows: an individualized approach

“…172 Tenecteplase may result in successful recanalization and therefore avert EVT in up to one in five LVO treatments. 173,174 However, tenecteplase has not yet been tested in RCTs in late time windows and cannot be recommended. clinical scenarios; IVT for WUS may be an exception, since we now have at our disposal two treatment paradigms, one based on perfusion imaging and another based on MRI, both of which may be used to select AIS patients for systemic thrombolysis.…”

“…172 Tenecteplase may result in successful recanalization and therefore avert EVT in up to one in five LVO treatments. 173,174 However, tenecteplase has not yet been tested in RCTs in late time windows and cannot be recommended. 12 EVT is unavailable in this scenario.…”