Abstract Body: Introduction: Complete recanalization of cerebral arteries is a strong predictor for good functional outcome in ischemic stroke. We hypothesize that successful recanalization (SR) results in better functional outcomes in patients presenting with minor ischemic stroke.

Methods: Data are from TEMPO-2, a phase 3, multi-center randomized controlled trial comparing tenecteplase with standard of care(control) in patients presenting with minor stroke (NIHSS≤5) and intracranial occlusion/focal perfusion abnormality ≤12h of onset. Among those enrolled based on CTA with visible occlusion, a follow-up CTA was done at 4-8h after randomization. Primary outcome was return to baseline neurological functioning using modified Rankin scale (mRS) at 90 days. Secondary outcomes included functional (90-d mRS 0-1, 0-2) and safety outcomes (symptomatic intracerebral hemorrhage (SICH), mortality, progression of stroke). Patients with SR [SR+, defined as revised Arterial Occlusive Lesion score (rAOL) ≥2b/3] were compared to those without successful recanalization (SR-), on follow-up CTA. Mixed effects Poisson regression was used to assess the association of SR with outcomes after adjusting for sex, baseline stroke severity, treatment type and onset to randomization time.

Results: Of the 638 with occlusion on baseline CTA, 516(59.6%) with follow up CTA were included. Of these, 178(34.5%) [122 (68.5%): tenecteplase, 56 (31.5%): control] had successful recanalization (SR+) and 338 (65.5%)[136: tenecteplase, 202: control] did not achieve successful recanalization (SR-). Baseline characteristics in the two groups were similar across all groups (Fig.1). Patients with SR+ had significantly higher rate of primary outcome as compared to SR- [80.3% vs 66.3%, adjRR 1.21 (95% CI 1.11-1.32)]. These results were consistent for all secondary functional outcomes (Fig. 2). Patients with SR+ had significantly lower rates of stroke progression as compared to SR- [2.8% vs 13%, adjRR 0.21 (95% CI 0.13-0.34)]. Within the SR+ group, there was no difference in the primary outcome and secondary functional outcomes between tenecteplase and control arm (Fig. 3).

Conclusion: We found that recanalization improved functional outcomes in both the tenecteplase and the control arm in minor stroke patients with intracranial occlusion. Although numerically larger recanalization was seen in the tenecteplase arm this did not translate into statistically significant improved functional outcomes.