Effect of Intra-Arterial Tenecteplase on Infarct Volume in Acute Ischemic Stroke

Introduction Adjunct intra‐arterial (IA) tenecteplase (TNK) may improve microvascular patency post thrombectomy in acute ischemic stroke patients. We determined the effect of IA‐TNK on infarct volume in large vessel occlusion (LVO) acute ischemic stroke (AIS). Methods We analyzed the clinical data of AIS‐LVO patients who received IA‐TNK endovascular thrombectomy (EVT) and EVT alone. Infarct volume on post‐intervention MRI (24‐48 hours post procedure) was calculated using 3D Slicer software. We compared infarct volumes between the groups using one‐way ANOVA, and Pearson correlation assessed the relationship between infarct volume and last known modified Rankin Scale (mRS). Statistical analysis was performed using R (version 4.1.2). Results A total of 56 patients with LVO‐AIS who underwent EVT were included;14 patients received adjunctive IA‐TNK and 42 received EVT alone. Post‐procedure, the proportion of patients who achieved Thrombolysis in Cerebral Infarction (TICI) ≥ 2b was 100% vs. 88.0% in patients who received adjunctive IA‐TNK and those who received EVT alone. The mean (± SE) infarct volume on post‐intervention MRI was significantly smaller in the EVT‐TNK (33.0 ± 9.2 cm³ vs. 58.8 ± 10.1 cm³, p = 0.06). The median (IQR) last known mRS was 2.5 (1‐4) vs. 3.0 (2‐6) with 50% vs. 35.7% achieved mRS 0‐2 in patients who IA TNK and those who received EVT alone. A significant correlation was found between infarct volume and last known mRS in the overall cohort. Conclusions Adjunctive IA‐TNK with EVT in LVO‐AIS patients resulted in smaller post‐intervention infarct volumes compared to EVT alone.