Abstract Body: Introduction
Thrombolytic and mechanical thrombectomy therapies are the current standard of care for large vessel occlusion (LVO) stroke. Multiple studies emphasized the impact of time metrics on patient outcomes, particularly door-to-needle and door-to-puncture (DTP) times. Tenecteplase (TNK) offers potential advantages over alteplase (tPA), including a simplified one-time bolus administration, which may reduce DTP time. While studies suggested TNK is non-inferior to tPA in terms of clinical outcomes, few large cohort studies have compared DTP times between patients receiving TNK or tPA prior to thrombectomy. This study aimed to compare DTP times and outcomes at discharge in patients treated with TNK versus tPA before thrombectomy.

Methods
We conducted a retrospective analysis of patients treated at three comprehensive stroke centers (CSC) in Texas, United States that transitioned from tPA to TNK between October 2019 and March 2023. The study included patients who received either tPA or TNK followed by thrombectomy and excluded those with DTP times exceeding 180 minutes. Baseline characteristics were compared. The primary outcome was DTP time. Secondary outcomes were TICI scores and ambulatory status upon discharge. Data was extracted from Get with the Guidelines (GWTG) Stroke Patient Management Tool.

Results
A total of 102 patients were included, with 53 receiving TNK and 49 receiving tPA. Baseline characteristics were similar between groups (Table 1). Patients in the TNK group had significantly faster DTP time compared to the tPA group, with a median time (IQR) of 81 [65, 105] vs 104 [81, 128] minutes (P=0.005) (Figure 1). No significant differences were observed in door-to-needle, door-to-imaging, or imaging-to-needle times; however, the needle-to-puncture time was notably shorter in the TNK group, median (IQR) 43 [27, 63] vs 60 [43, 83] minutes (P=0.003) (Figure 2). There were no significant differences between the groups in terms of TICI scores or ambulatory status upon discharge.

Conclusion
Our analysis of CSCs that transitioned to TNK found reduced DTP times compared to tPA. This finding was driven by shorter needle-to-puncture times and thus, may be due to the simplified, single bolus TNK administration. Both TNK and tPA groups yielded high rates of successful recanalization and similar functional outcomes at discharge. Given its faster DTP time, TNK may be a better option for LVO stroke patients requiring both thrombolysis and thrombectomy.