Abstract Details

Title Tenecteplase is Safe and Efficacious in Telestroke Patients with Confirmed Large Vessel Occlusions

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S17 - Cerebrovascular Disease: Clinical Trials and Outcomes Studies (4:42 PM-4:54 PM)

Poster/Presentation
Number 007

Background

Tenecteplase has been demonstrated to be an effective option for thrombolysis in patients with acute ischemic stroke (AIS) due to LVO. Data is scarce concerning tenecteplase usage in telestroke patients.

Objective

Evaluate if tenecteplase is safe and feasible for patients with confirmed large vessel occlusion (LVO) in a large telestroke network.

Design/Methods Retrospective analysis of AIS patients with LVO and treated with thrombolysis. We compared outcomes in telestroke patients treated with IV alteplase (May 2018 – April 2020) to patients treated with IV tenecteplase (May 2020 – April 2021). We evaluated primary efficacy and safety outcomes: 90 day functional outcome as measured by modified Rankin Scale (mRS) and complications related to thrombolysis. Secondary outcomes included door to needle time (DTN) and door in door out time (DIO). Ordinal regression assessed 90 day mRS and binomial logistic regression analysis evaluated complications between the groups. Quantile regression models were used to compare groups for DTN and DIO.

Results

There were 3747 telestroke consults during the study period and 537 (14.3%) were found to have an LVO, of which 109 (39 tenecteplase; 70 alteplase) were eligible, received thrombolysis and were included in this study. Patients treated with tenecteplase had significantly less disability at 90 days compared to patients treated with alteplase [1 (0 – 4.5) vs. 3 (1 – 6)], adjusted odds ratio (aOR)=0.31 [95%CI, 0.14 – 0.72], p=0.006, based on mRS ordinal shift analysis. Similar complication rates were reported between the thrombolysis groups, aOR=3.73 [95%CI, 0.23 – 59.95], p=0.35. An adjusted quantile regression model found tenecteplase was administered 9.40 minutes quicker than alteplase, standard error (SE)=3.67, [95%CI, 2.11 – 16.69], p=0.01. There were no differences in DIO, p=0.63.

Conclusions

Telestroke patients with confirmed LVO and treated with tenecteplase were found to have better 90 day outcomes compared to patients treated with alteplase, without increased complication rates.

Authors/Disclosures
Chris Hackett, MA PRESENTER	Mr. Hackett has nothing to disclose.
Konark Malhotra, MD (Allegheny Health Network)	Dr. Malhotra has nothing to disclose.
Russell M. Cerejo, MD (Allegheny health Network)	Dr. Cerejo has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Ischemaview.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Sandeep S. Rana, MD, FAAN (Allegheny Health Network)	Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CSI. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pharmawrite. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenx. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for amylyx. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion.
Robert Fishman, MD (Butler Hospital)	Dr. Fishman has nothing to disclose.
David G. Wright, MD	Dr. Wright has nothing to disclose.
	No disclosure on file
Ashis H. Tayal, MD	Dr. Tayal has nothing to disclose.