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Tenecteplase Averting Mechanical Thrombectomy in Emergent Large Vessel Occlusion

Psychogios, Klearchos MD*; Kargiotis, Odysseas MD*; Safouris, Apostolos MD*; Magoufis, Georgios MD*; Liakakis, Georgios MD*; Stamboulis, Eleftherios MD*; Tsivgoulis, Georgios MD, FESO†,‡,§

doi: 10.1097/NRL.0000000000000244
Case Report/Case Series

Introduction: Tenecteplase has recently been studied as an alternative thrombolytic agent in acute stroke, with a possible superior effect in achieving reperfusion of large intracranial vessels.

Case Report: A 90-year-old female patient was admitted to our stroke unit because of acute onset of dysarthria, left-sided neglect, and hemiparesis. Brain computed tomography (CT) coupled with CT angiography and CT perfusion (postprocessed with the use of RAPID software) demonstrated right proximal middle cerebral artery occlusion with a large penumbra/small ischemic core pattern. The patient was subsequently treated with bolus tenecteplase infusion (0.25 mg/kg). Mechanical thrombectomy was abandoned because the patient has rapidly improved. The patient was discharged to her own home 4 days later with no neurological deficit and functionally independent (modified Rankin scale of 0).

Conclusion: This case exemplifies the potential of tenecteplase in achieving swift reperfusion in patients with large vessel occlusion associated with a substantial mismatch penumbral pattern.

*Stroke Unit, Metropolitan Hospital, Piraeus

Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece

Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN

§Department of Neurology, International Clinical Research Center, St. Anne’s University Hospital in Brno, Brno, Czech Republic

G.T. has been supported by the European Regional Development Fund—Project FNUSA-ICRC (No. CZ.1.05/1.1.00/02.0123). The remaining authors declare no conflict of interest.

Correspondence to: Klearchos Psychogios, MD, Stroke Unit, Metropolitan Hospital, Ethnarchou Makariou 9, Neo Faliro, Piraeus 18547, Greece. E-mail:

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