Background and Purpose Admission hyperglycemia is an independent predictor of poor functional outcome in acute ischemic stroke. Stroke thrombolysis with alteplase (TPA) among patients with admission hyperglycemia is associated with increased risk of symptomatic intracranial hemorrahge (sICH) and decreased recanalization rates. Lately, tenecteplase (TNK) has been established as a non-inferior alternative to TPA in acute ischemic stroke care. The impact of admission hyperglycemia in TNK compared to TPA prior to large vessel occlusion (LVO) stroke thrombectomy requires further investigation.

Methods LVO stroke patients who received intravenous thrombolysis with TPA or TNK before endovascular treatment were retrospectively reviewed. During the study period 01/2020 - 06/2023, the authors’ stroke-systems switched from TPA to TNK as their primary thrombolytic. Of consecutive 569 patients, 476 met inclusion criteria: proximal LVO, pre-stroke modified Rankin Scale (mRS) < 3, last-known-well to intravenous thrombolysis (LKW-to-IVT) ≤ 4.5 hours. Admission hyperglycemia was defined as ≥ 140 mg/dl and sICH as parenchymal hemorrhage associated with neurological decline of National Institute of Health Stroke Scale (NIHSS) ≥ 4. Multivariate logistic analysis was performed.

Results Among 476 patients, 261 (54.8%) received TNK and 215 (45.2%) TPA prior to EVT. The site of occlusion was the M1 middle cerebral artery (MCA) (45.6%), M2 MCA (27.9%), internal carotid artery (14.3%), tandem carotid with M1 or M2 MCA (9.5%) and basilar artery (2.7%). Baseline demographics (age, sex, NIHSS, LKW-to-IVT, Alberta Stroke Program Early CT Score) and admission hyperglecmia rates (TNK 32.8% and TPA 33.5%) were comparable. Admission hyperglycemia was significantly associated with sICH (area under the curve 0.71, 95% CI 0.66 - 0.75, p=0.003). In multivariate analysis, admission hyperglycemia remained independently associated with sICH (adjusted odds ratio 3.9, 95% CI 1.3 - 12.0, p=0.017). Admission hyperglycemia effects were similar in TNK compared to TPA groups.

Conclusions Among LVO stroke patients receiving intravenous thrombolysis prior to EVT, admission hyperglycemia is significantly associated with risk of sICH. The detrimental effects of admission hyperglycemia were similar with TNK compared to TPA prior to EVT.

Disclosures P. Hendrix: None. P. Koul: None. C. Schirmer: None. M. Lang: None. A. Al-Bayati: None. R. Nogueira: None. B. Gross: None.