2026 American Academy of Neurology Abstract Website

Objective:

To compare final cerebral infarct volumes (FIV) among diabetic and non-diabetic patients treated with Alteplase (TPA) or Tenecteplase (TNK) and determine whether either thrombolytic agent is associated with better clinical outcome.

Background:

Diabetes mellitus (DM) and larger FIV are known determinants of poor clinical outcomes in acute ischemic stroke (AIS). Our preliminary study reported improved clinical outcome among DM patients treated with TNK, but it is unknown whether TNK treatment results in smaller FIV.

Design/Methods:

Retrospective analysis of AIS patients with premorbid modified Rankin score (mRS) of 0-2 and treated with TPA or TNK over a 5-year period. FIV was measured on 24-h post-intervention CT/MRI using image segmentation. A mRS of 0-2 and 3-6 at 3 months was regarded as favorable and unfavorable outcomes, respectively. Intra-group analysis was performed using univariate tests, while inter-group analysis was conducted via multivariable regression.

Results:

Two hundred and ninety-two patients met the inclusion criteria (DM: n=97, non-DM: n=195). Among DM patients, there was over a two-fold odds of achieving 3-month favorable outcome with TNK compared to TPA was (odds ratio (OR [95% CI]): 2.39 [1.04, 5.50], p=0.043]. In non-DM patients, the OR was 2.18 [95% CI (1.20, 3.96), p=0.011]. The median FIV in the entire cohort was 11.9 (IQR: 1.6-59.4), with 20.0 (IQR: 1.4-73.0) for diabetic and 10.0 (IQR: 2.0-50.0) for non-diabetic patients (p=0.522). There was a strong positive correlation between FIV and 3-month mRS (Pearson r=0.600, p<0.001). In a multivariable model adjusting for treatment, presence of DM was associated with an 88% increased odds of unfavorable outcome and every 1 mL increase in FIV associated with 4% increased odds (p<0.001).

Conclusions:

Smaller FIV and thrombolysis using TNK were associated with favorable 3-month mRS in both diabetic and non-diabetic patients. This suggests a pharmacological superiority of TNK compared to TPA.