Intra-Arterial Tenecteplase Reduces Infarct Volume in Acute Ischemic Stroke Post-Thrombectomy

Introduction Adjunct intra‐arterial (IA) Tenecteplase (TNK) has been proposed to improve microvascular patency post thrombectomy in acute ischemic stroke patients. This study explores the effect of IA‐TNK on infarct volume in large vessel occlusion (LVO) acute ischemic stroke (AIS). Methods Charts of AIS‐LVO patients who received IA‐TNK with endovascular thrombectomy (EVT) and EVT alone were retrospectively reviewed. Infarct volume on post‐intervention MRI was calculated using 3D Slicer software. One‐way ANOVA compared infarct volumes between groups, and Pearson correlation assessed the relationship between infarct volume and last known modified Rankin Scale (mRS). Mortality and last known mRS were reported as proportions. 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 who 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. 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 know mRS was 2.5 (1‐4) vs. 3.0 (2‐6) with 50% vs. 35.7% achieved mRS 0‐2. A significant correlation was found between infarct volume and last know 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.