Objective:

To report the safety of Tenecteplase (TnK) in a pediatric patient with acute ischemic stroke (AIS).

Background:

The Thrombolysis in Pediatric Stroke (TIPS) study aimed to assess alteplase's (tPA) safety in pediatric ischemic stroke but struggled with recruitment, enrolling only 1 of 93 screened patients. TnK has shown advantages over tPA for treating AIS in adults with faster administration, better pharmacokinetics, cost-effectiveness, improved large vessel recanalization rate, and a similar safety profile. However, its use in pediatric stroke is rare, with only two previous cases reported. One case involved a 15-year-old who improved from an National Institutes of Health Stroke Scale (NIHSS) score of 7 to 0 post-TnK and mechanical thrombectomy. The second reported case involved a 13-year-old patient who showed no significant symptom change but also no major complications. This report describes the third pediatric patient to ever receive this medication.

Design/Methods:

Case report

Results:

A 14-year-old male with autism and paroxysmal supraventricular tachycardia (SVT) presented for global aphasia, left-sided weakness, facial droop, gaze preference, and sensory deficits (NIHSS 20). Imaging revealed occlusion in the right middle cerebral artery, common carotid artery, and internal carotid artery. He was treated with TnK (0.25 mg/kg) at 3 hours and 32 minutes post symptom onset and underwent mechanical thrombectomy. Partial recanalization was achieved with Thrombolysis in Cerebral Infarction score of 2b (TICI 2b). Decompressive hemicraniectomy was performed on day two for cerebral edema and midline shift, with stable hemorrhagic conversion (parenchymal hematoma type 1) seen on follow-up imaging. Anticoagulation was later started for central line-associated thrombosis and aspirin for secondary stroke prevention. At a follow-up visit on day 88, he showed improved left-sided weakness and speech.

Conclusions:

Our case supports the safety of TnK in the pediatric population. Further research is needed to assess safety, dosage, and efficacy in this cohort.