Tenecteplase in practice: A rural tele-stroke network's experience

Area of Science:

• Neurology
• Cardiovascular Medicine
• Emergency Medicine

Background:

• Alteplase (tPA) and Tenecteplase (TNK) are FDA-approved thrombolytics for acute ischemic stroke (AIS).
• Real-world data on TNK's effectiveness in rural settings is crucial post-approval.
• A South Carolina telestroke network transitioned from tPA to TNK in August 2023.

Purpose of the Study:

• To explore the real-world experience of transitioning from tPA to TNK within a rural telestroke network.
• To compare the safety, efficiency, and functional outcomes of TNK versus tPA in AIS treatment.

Main Methods:

• Retrospective analysis of AIS patients receiving thrombolytics between 2022-2024 in the MUSC Telestroke Network.
• Comparison of outcomes between tPA and TNK groups, with subgroup analyses for large vessel occlusion (LVO) and spoke center patients.
• Assessment of safety, efficiency metrics (door-to-needle time), and functional outcomes (modified Rankin Scale - mRS).

Main Results:

• Of 302 patients receiving thrombolytics, 144 received TNK and 158 received tPA.
• Median door-to-needle times were similar (TNK 45 min vs. tPA 42 min, p=0.6).
• No significant differences in symptomatic hemorrhage or hospital length of stay were observed.
• For LVO patients treated at the hub, TNK was associated with fewer mechanical thrombectomy passes (median 1 vs. 2, p=0.046) and higher functional independence (mRS ≤3: 75.4% vs. 54.4%, p=0.02).

Conclusions:

• The system-wide transition to TNK demonstrated comparable safety and treatment times to tPA.
• TNK use led to improved procedural efficiency and functional independence in LVO patients.
• Findings support TNK adoption in AIS management, especially in resource-constrained telestroke and rural settings.