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Updated: May 13, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Effect of adjunctive intra-arterial tenecteplase on infarct volume in acute ischemic stroke patients undergoing
Muhammad Shakir1, Sarada Prasad2, Yilung Huang3
1Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, United States.
Background:
Adjunct intra-arterial (IA) tenecteplase (TNK) may improve microvascular patency postthrombectomy in acute ischemic stroke (AIS) patients. We determined the effect of IA-TNK on infarct volume in large vessel occlusion (LVO) AIS.
Methods:
We analyzed the clinical data of AIS-LVO patients who received IA-TNK after endovascular thrombectomy (EVT) and EVT alone. Infarct volume on postintervention magnetic resonance imaging (MRI) (24-48 h postprocedure) was calculated using 3D Slicer software. We compared infarct volumes between the groups using one-way analysis of variance, 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. Postprocedure, the proportion of patients who achieved thrombolysis in cerebral infarction ≥2b was 100% versus 88.0% in patients who received adjunctive IA-TNK and those who received EVT alone. The mean (±standard error) infarct volume on postintervention MRI was significantly smaller in those who received IA-TNK (33.0 ± 9.2 cm3 vs. 58.8 ± 10.1 cm3, P = 0.06). The median (interquartile range) last known mRS was 2.5 (1-4) versus 3.0 (2-6) with 50% versus 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.
Conclusion:
Adjunctive IA-TNK with EVT in LVO-AIS patients resulted in smaller postintervention infarct volumes compared to EVT alone.
