Thrombolysis with novel tenecteplase in acute ischemic stroke: A prospective observational study from a rural tertiary care center in South India

Abstract

Tenecteplase is an approved engineered recombinant tissue plasminogen activator for treatment of acute ischemic stroke with molecular and practical advantages. It could be quintessential in this era of endovascular care provided that more studies come out, especially from resource poor settings. To observe the clinico-epidemiological profile and to assess the outcome of acute ischemic stroke patients treated with tenecteplase. A prospective observational study of stroke patients treated with tenecteplase. On admission clinical characteristics, temporal, epidemiological, imaging parameters, outcome measures including baseline NIHSS, NIHSS at 1 hour, 24 hours, at discharge, and modified Rankin Scores (mRS) at 0, 1 and 3 months were recorded in a structured proforma. Out of the 19 patients thrombolysed with tenecteplase 68.4% were males. Mean age of the study population was 61.3 years. Hypertension (57.9%), diabetes mellitus (36.8%) and smoking(26.3%) were the most common risk factors.Time parameters like mean onset to door time, door to image and door to needle time were 126 minutes, 29minutes and 66 minutes respectively, which were confirming with the international standards. Mean NIHSS was 11.1 and serial improvement was noted in the post treatment mean NIHSS scores at 1 hours, 24 hours and 7days with values of 8.6,8.0 and 7.7 respectively ( F=5.619,p=0.018). The mean mRS score was 3.5 and the follow up mRS at 1 month (2.4) and 3 months (1.7) (F=19.32, p<0.001) revealed significant functional improvement. The spearman test showed a positive correlation of age with all the serial post treatment NIHSS and mRS scores even when it did not affect the baseline NIHSS and mRS scores suggesting a poor response to tenecteplase with increasing age. Major improvement in mRS scores described as either a score of 0 or 1 or else a three-point improvement from baseline was seen in 47% (9) of thrombolysed patients and a major improvement in NIHSS scores was seen in 26% (5) patients. Symptomatic intracranial hemorrhage (sICH) was seen in only 5% of the study population. Thrombolysis with tenecteplase is faster, safer and effective but the treatment response decreases with increasing age.