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Publications

Journal Article Ahead of print

PubMed: 41781210 DOI: 10.1136/jnis-2025-024846

When lysis moves the target: thrombus migration after tenecteplase and its impact on endovascular recanalization.

J Neurointerv Surg

Authors: Guillaume Tessier, Gaspard Gerschenfeld, Jonathan Cortese, Laurent Spelle, Laura Venditti, Nicolas Chausson, Didier Smadja, Stephane Olindo, Gaultier Marnat, Guillaume Turc, Wagih Ben Hassen, Pierre Seners, Michel Piotin, Emmanuel Wiener, Fernando Pico, Frédéric Clarençon, Sonia Alamowitch, Jildaz Caroff

Affiliations

  • Neuroradiology Department, CHU Nantes, Saint-Herblain, France.
  • AP-HP, Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, FHU NeuroVasc 2030, GRC NOVA, Sorbonne Université, ICM, Paris, France.
  • Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Team Turc, Paris, France.
  • NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicêtre Hospital, APHP, Le Kremlin-Bicetre, France.
  • Paris-Saclay University, Faculty of Medicine, Le Kremlin-Bicetre, France.
  • Service de Neurologie Adultes, AP-HP, CHU Bicêtre, FHU NeuroVasc 2030, Le Kremlin-Bicêtre, France.
  • Department of Neurology, Centre Hospitalier Sud Francilien, Université Paris-Saclay, France, Corbeil-Essonnes, France.
  • Department of Vascular Neurology CHU Bordeaux GH Pellegrin, Bordeaux, France.
  • Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, France.
  • Neurology Department, GHU Paris Psychiatrie et Neurosciences, Paris, France.
  • Paris Cité University, Paris, France.
  • Interventional Neuroradiology, Saint Anne Hospital Centre, Paris, France.
  • INSERM U1166, Paris, France.
  • Neurology, Hopital Fondation Adolphe de Rothschild, Paris, France.
  • Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France.
  • Neurology, The University Hospitals of Strasbourg Hautepierre Hospital, Strasbourg, France.
  • Department of Vascular Neurology, Versailles Hospital, Versailles, France.
  • University Versailles Saint-Quentin-en-Yvelines, Versailles, France.
  • Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris, France.
  • Sorbonne University, Paris, France.
  • NEURI The Brain Vascular Center, Interventional Neuroradiology, Bicêtre Hospital, APHP, Le Kremlin-Bicetre, France.
  • INSERM, UMR_S1176,Paris-Saclay University, Le Kremlin-Bicêtre, France.

Abstract

BACKGROUND

Thrombus migration (TM) is more common after intravenous thrombolysis (IVT) with tenecteplase (TNK) compared with alteplase. We aimed to determine TM impact over endovascular thrombectomy (EVT) results in patients undergoing TNK-IVT for acute ischemic stroke.

METHODS

We retrospectively included all patients with large vessel occlusion of the anterior circulation, treated with TNK-IVT and eligible for EVT between January 2015 and February 2021, from a large observational TNK registry (Tenecteplase Treatment in Ischemic Stroke-TETRIS). TM was defined by a distal shift of the occlusion site between initial non-invasive imaging and digital subtraction angiography (DSA) before endovascular thrombectomy. We compared angiographic (revised Treatment In Cerebral Infarction-rTICI) and functional (modified Rankin Scale-mRS) outcomes in cases of TM versus no TM.

RESULTS

Out of 580 enrolled patients, TM occurred between the initial imaging and the first DSA run in 209 (36.0%) of them. TM led to EVT being impossible to perform in 26% of cases (vs 4% in absence of TM). Longer needle-to-groin time and shorter susceptibility vessel sign length were independently associated with TM. Rates of successful recanalization (rTICI 2b/3) were similar between groups. However, we observed higher rates of excellent (rTICI 2c/3) (64.8% vs 51.7%, P=0.02) and complete reperfusion (rTICI 3) (46.6% vs 27.8%, P<0.001) in the absence of TM, but with no impact on clinical outcomes (mRS 0-2=44.7% in the non-migration group vs 47.1% in the migration group; P=0.59).

CONCLUSION

TM is a frequent and time-related consequence of TNK-IVT that hinders recanalization rates but does not impact functional outcomes.

MeSH

Ischemic Stroke, Absenteeism, Tenecteplase, Thrombectomy