Objective:
To evaluate the role of Collaterals and Clot Burden in patients getting Tenecteplase as opposed to Alteplase
Background:
Despite increasing rates of revascularisation, outcomes are not universally positive and are dependent on clinical and imaging characteristics of patients. Collateral cerebral blood flow (Collarteral Score(CS – 0-2)) is a key determinant of both good clinical outcomes and capacity to benefit from thrombectomy, in both early and late presenting patients. Clot Burden Score (CBS) is shown to be independently associated with functional outcome. One of the randomized controlled trial shows the rate of revascularization of 20% with the use of Tenecteplase (TNK) as compared to 10% with Alteplase (TPA).
Design/Methods:
We retrospectively collected data on consecutive patients admitted to comprehensive stroke center. Inclusion criteria is large vessel occlusion (either M1 or supraclinoid ICA occlusion) and received thrombolysis. After screening through last 600 patients, we found 102 patients with inclusion criteria and required imaging data. Analysis was made between two groups based on whether they received TPA vs TNK to understand the importance of Clot burden score and Collateral score in pre-thrombolysis and post-thrombolysis imaging
Results:
On post-thrombolysis and pre-thrombectomy vessel imaging, CBS>/=6 found to be better in patients receiving TNK (65%) as compare to TPA (55%). No difference is being noticed in collateral score between two groups. In about 10% of patients receiving TNK, improvement is seen in clot burden in pre and post thrombolysis imaging including complete recanalization
Conclusions:
Recanalization is often seen as major imaging favorable outcome in patients receiving thrombolysis even though decrease in clot burden as well as improvement in collaterals are also shown to have favorable outcome in patients. The major limitation of this study is being retrospective and size. We would recommend to include CBS and CS as standard imaging markers in future large clinical trials to improve our understanding
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.