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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

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Intravenous Tenecteplase for Acute Ischemic Stroke During Active Menstruation.

Nathan A Baisden¹, Jordan Preston¹, Justin Nolte¹

¹Neurology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.

|September 19, 2024

Summary

This case study discusses treating a menstruating woman with acute ischemic stroke using tenecteplase (TNK). The patient recovered fully without adverse events, suggesting TNK may be safe for menstruating women with stroke.

Keywords:

: ischemic stroke alteplase (tpa)female reproductive menses stroke stroke thrombectomy tenecteplase (tnk)young adult ischemic stroke

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Area of Science:

Neurology
Emergency Medicine
Pharmacology

Background:

Acute ischemic stroke requires timely treatment with thrombolytic therapy.
Intravenous tenecteplase (TNK) is increasingly used for acute ischemic stroke.
Menstruation presents a potential relative contraindication for thrombolysis due to bleeding risk.

Observation:

A 51-year-old female presented with stroke symptoms within the therapeutic window.
Initial CT and CT perfusion imaging confirmed left parieto-occipital ischemia.
The patient was actively menstruating, a potential relative contraindication for TNK.

Findings:

Despite active menstruation, the patient received IV TNK after electing to proceed.
No adverse events or complications related to bleeding occurred post-treatment.
Neurological deficits completely resolved at the follow-up clinic visit.

Implications:

This case highlights the need to consider TNK use in menstruating women with acute ischemic stroke.
Active menstruation may not be an absolute contraindication for TNK if other factors are favorable.
Further investigation is warranted to establish definitive guidelines for TNK use in this population.