Extending Intravenous Tenecteplase Beyond 4.5-hour Window for Patients with Acute Ischemic Stroke

The only options for patients presenting with acute ischemic stroke beyond 4.5 hours of last known well time who do not meet criteria for extended window treatment with endovascular therapy are medical management and evaluation for rehab. Up to half of “wake-up” or unwitnessed strokes might be eligible for IV thrombolytic treatment with either alteplase or tenecteplase (TNKase). Recent trial data suggest that these patients may be screened successfully with a MRI brain or CT perfusion study to determine eligibility for IV alteplase. We aim to screen all eligible patients presenting with either wake-up stroke or acute stroke symptoms in the 4.5- to 9-hour window meeting clinical criteria with either MRI brain or CT perfusion; to treat those who meet criteria with IV TNKase; and to compare 90-day outcomes and rates of symptomatic intracranial hemorrhage with those from clinical trials.

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