Priyanka V Kashyap, Vaibhav O P Pandey
TNK use had robust success in lowering NIHSS scores, particularly in LVOs, with excellent safety, being a single bolus, more cost-effective, no time wastage for infusion preparation supporting its preference over standard alteplase. TNK may be a better choice in resource-limited set-up. Multicentre trials are needed for its widespread adoption and also for its conjunctive use with mechanical thrombectomy.
BACKGROUND: Intravenous thrombolysis with alteplase has been the standard for acute ischaemic stroke (AIS) within 4.5 h, but tenecteplase (TNK) is gaining promising corner in intravenous thrombolysis with some unique features and superior efficacy in large vessel occlusion (LVO).
PURPOSE: This study evaluates real-world TNK outcomes at a Central Indian tertiary centre.
METHODS: This ambispective single-centre study included 36 AIS patients presenting within <4.5 h of onset, meeting inclusion criteria (age >18 years, National Institutes of Health Stroke Scale (NIHSS)-assessed, blood pressure <185/110 mmHg, no contraindications). Weight-based TNK (0.25 mg/kg bolus) was administered. NIHSS was noted at admission, 48 h, 7 days and discharge; modified Rankin Scale at discharge and at 90 days was also recorded. Demographics, comorbidities, vessel angiography status and complications were analysed using descriptive statistics and t-tests (p < .05 significant).
RESULTS: The mean age was 57.67 ± 14.32 years, and 75% of patients were males. Hypertension (61.1%) and smoking (30.6%) were the predominant comorbidities. Mild stroke (NIHSS 1-5) occurred in 58.33% of cases, and LVOs were present in 27.78% (bilateral internal carotid artery (ICA) in 13.89%, middle cerebral artery M1/M2 in 13.89%). Patients with bilateral ICA occlusions experienced a mean NIHSS reduction of 6 points, compared to 3.5 points in others (p = .0188). Successful thrombolysis with TNK was achieved in 77.78% of cases. Complications included haemorrhagic transformation in 8.33% and mortality in 8.33% (unrelated to TNK). Age and comorbidities did not predict outcomes (p > .05).
CONCLUSION: TNK use had robust success in lowering NIHSS scores, particularly in LVOs, with excellent safety, being a single bolus, more cost-effective, no time wastage for infusion preparation supporting its preference over standard alteplase. TNK may be a better choice in resource-limited set-up. Multicentre trials are needed for its widespread adoption and also for its conjunctive use with mechanical thrombectomy.