Dr. S Srikanth Reddy

Background and Objectives: Clinical trials showed a higher recanalization rate of tenecteplase (TNK) over alteplase in large vessel occlusion (LVO) and better functional independence at the end of 3 months without increasing the risk of systematic intracranial haemorrhage (SICH). Indian data on the efficacy of tenecteplase as bridging therapy in LVOs are scarce. We aimed to review the outcomes and safety of tenecteplase up to 4.5 h in LVO patients who were taken for mechanical thrombectomy (MT). Methods: This is a single-center retrospective study. Patients with acute ischemic stroke who had LVO and were taken to an angiographic suit for MT were included in the study. Other inclusion criteria were an age of more than 18 years, National Institute of Health Stroke Scale >4, modified Rank in score (mRS) of 2 or less before stroke, and no evidence of hemorrhage on noncontrast computed tomography of brain. The primary efficacy outcome was mRS score of 0–2 at the end of 3 months. Development of symptomatic intracerebral hemorrhage was considered the primary safety outcome. Results: A total of 27 patients were included in this study. The mean age of presentation was 61 years. Most of the study subjects were males 59.25%. Hypertension was the most common risk factor seen in 19 (70.37%) of subjects. About 11 patients (40.74%) had M1 occlusion, 6 (22.22%) subjects had M2 occlusion, 8 (29.62%) patients had internal carotid artery occlusion, and 2 (7.4%) subjects had basilar occlusion. Early recanalization with IV thrombolysis (IVT) was noted in 5 (18.51%) of patients after IVT with tenecteplase. Functional independence (mRS: 0–2) was achieved in 15% (55.55%) of patients. Symptomatic intracranial hemorrhage was seen in 1 (3.7%) subjects and death within 90 days is noted in 3/27 (11.11%) subjects. Conclusion: Tenecteplase is appearing to be an effective bridging agent before MT in LVOs considering its ease of administration, low cost, effective recanalization rates, and good functional recovery.