Objective:

NA

Background:

Over the past decade, Tenecteplase (TNK) has been proposed as an alternative thrombolytic agent to alteplase in adult acute ischemic stroke (AIS) patients. However, there is no data on TNK use in the pediatric population. The most updated pediatric stroke guidelines recommend tPA for children >2 yrs old with disabling neurological deficits within 4.5 hrs from symptom onset. TNK is more fibrin specific and has more resistance to plasminogen activator inhibitor, therefore may achieve better clot lysis compared to alteplase. TNK use in children is limited to few published cases for cardiac indications with good outcomes. Our case is the first reported pediatric patient to be treated with TNK for AIS.

Design/Methods:

NA

Results:

A 15-year-old male with a medical history of recent presumed bilateral tinea pedis currently on fluconazole presented to the emergency department (ED) with left-sided weakness and numbness which started 30 minutes before arrival at the ED. The initial blood pressure was 128/59 and blood glucose level was 119 mg/dL. The initial National Institute of Health Stroke Scale (NIHSS) was 7: 2 for left facial palsy, 3 for left arm weakness, and 2 for left leg weakness. Computerized tomography of the head demonstrated no acute abnormality. CT angiography (CTA) of the head and neck showed a nonocclusive thrombus in the M1 segment of the right middle cerebral artery (MCA). He received tenecteplase 0.25 mg/kg with improvement of his NIHSS score to 6. He subsequently underwent successful endovascular thrombectomy with complete recanalization, after which his symptoms resolved, and he returned to neurologic baseline with NIHSS 0.

Conclusions:

TNK can be a safe and effective alternative to alteplase in the treatment of carefully selected children and adolescents with AIS. Further research in the pediatric population are needed to identify appropriate candidates, determine effective dosing, and delineate safety parameters.