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First Reported Case of Tenecteplase for Pediatric Acute Ischemic Stroke (P7-5.021).

Ahmed Elmashad1, Celia Fung1, Akash Chakravartty1

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Tenecteplase (TNK) offers a potential alternative to alteplase for pediatric acute ischemic stroke (AIS). This case study presents the first reported use of TNK in a pediatric AIS patient, demonstrating its safety and efficacy.

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Area of Science:

  • Neurology
  • Pediatric Stroke
  • Thrombolytic Therapy

Background:

  • Tenecteplase (TNK) is a proposed alternative thrombolytic to alteplase for adult acute ischemic stroke (AIS).
  • Current pediatric stroke guidelines recommend alteplase (tPA) for children over two years old with disabling neurological deficits within 4.5 hours of symptom onset.
  • TNK's increased fibrin specificity and resistance to plasminogen activator inhibitor suggest potential for improved clot lysis compared to alteplase.

Observation:

  • A 15-year-old male presented with acute left-sided weakness and numbness, diagnosed with an M1 segment right middle cerebral artery thrombus.
  • The patient received tenecteplase (0.25 mg/kg), resulting in an improved NIHSS score from 7 to 6.
  • Successful endovascular thrombectomy followed, achieving complete recanalization and full symptom resolution, returning the patient to baseline neurological function (NIHSS 0).

Findings:

  • This case represents the first reported instance of tenecteplase (TNK) administration for acute ischemic stroke (AIS) in a pediatric patient.
  • The patient experienced symptom improvement after TNK administration and complete neurological recovery post-endovascular thrombectomy.
  • The use of TNK in this pediatric AIS case was associated with positive outcomes.

Implications:

  • Tenecteplase (TNK) may serve as a safe and effective alternative thrombolytic agent for carefully selected pediatric and adolescent patients with acute ischemic stroke (AIS).
  • Further research is crucial to identify optimal candidates, establish effective dosing regimens, and define safety parameters for TNK use in the pediatric population.
  • This case highlights the potential for expanded therapeutic options in pediatric stroke management.