From the Guidelines
For acute ischemic stroke, the best time for TNK (tenecteplase) administration is within 4.5 hours of symptom onset, with earlier treatment providing better outcomes, as recommended by the most recent guidelines 1. The recommended dose is 0.25 mg/kg (maximum 25 mg) given as a single intravenous bolus.
Key Considerations
- Mechanical thrombectomy should be performed as soon as possible within 24 hours of symptom onset for patients with large vessel occlusion, with the greatest benefit seen when performed within 6 hours 1.
- Patient selection for thrombectomy beyond 6 hours requires advanced imaging to identify salvageable brain tissue.
- Both interventions follow the "time is brain" principle, as each minute of delay results in the loss of approximately 1.9 million neurons.
Pre-Treatment Requirements
- Prior to administering TNK, a non-contrast CT scan must be performed to rule out hemorrhage, and blood pressure should be controlled (below 185/110 mmHg) 1.
- For thrombectomy, rapid transfer to a comprehensive stroke center with neurointerventional capabilities is essential, and the procedure should be performed by experienced operators using stent retrievers or aspiration devices.
Additional Recommendations
- The technical goal of mechanical thrombectomy should be reperfusion to a modified Thrombolysis in Cerebral Infarction (mTICI) grade 2b/3 1.
- In patients with anticoagulant-associated spontaneous ICH, anticoagulation should be discontinued immediately, and anticoagulation should be reversed as soon as possible 1.
From the Research
Time Window for TNK and Thrombectomy in CVA
- The optimal time window for administering TNK (tenecteplase) and performing thrombectomy in patients with acute ischemic stroke is a critical factor in determining treatment outcomes 2, 3, 4, 5.
- According to the studies, TNK can be effective in patients with acute ischemic stroke due to large vessel occlusion, with improved recanalization rates and long-term functional outcomes compared to alteplase 2, 5.
- The current evidence suggests that TNK can be used as an alternative to alteplase, with a comparable safety and efficacy profile 5.
- Thrombectomy can be performed up to 24 hours after symptom onset, even in patients with a large ischemic core and those with an acute basilar artery occlusion 3.
- The use of TNK as a bridging therapy prior to thrombectomy may also be beneficial in patients with recurrent ischemic stroke within 3 months 6.
Dosing and Administration
- The recommended dose of TNK is 0.25 mg/kg, which has been shown to be effective in patients with large vessel occlusion 2, 5.
- TNK can be administered as a single bolus, which may reduce the door-to-needle time compared to alteplase 5.
Clinical Outcomes
- The studies suggest that TNK and thrombectomy can improve clinical outcomes in patients with acute ischemic stroke, including reduced neurological disability and improved functional outcome 2, 3, 4, 5.
- The use of TNK and thrombectomy may also reduce the risk of symptomatic intracranial hemorrhage and mortality 2, 5.