Tenecteplase Averting Mechanical Thrombectomy in Emergent Large Vessel Occlusion

Neurologist. 2019 Nov;24(6):180-182. doi: 10.1097/NRL.0000000000000244.


Introduction: Tenecteplase has recently been studied as an alternative thrombolytic agent in acute stroke, with a possible superior effect in achieving reperfusion of large intracranial vessels.

Case report: A 90-year-old female patient was admitted to our stroke unit because of acute onset of dysarthria, left-sided neglect, and hemiparesis. Brain computed tomography (CT) coupled with CT angiography and CT perfusion (postprocessed with the use of RAPID software) demonstrated right proximal middle cerebral artery occlusion with a large penumbra/small ischemic core pattern. The patient was subsequently treated with bolus tenecteplase infusion (0.25 mg/kg). Mechanical thrombectomy was abandoned because the patient has rapidly improved. The patient was discharged to her own home 4 days later with no neurological deficit and functionally independent (modified Rankin scale of 0).

Conclusion: This case exemplifies the potential of tenecteplase in achieving swift reperfusion in patients with large vessel occlusion associated with a substantial mismatch penumbral pattern.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Brain Ischemia / complications
  • Brain Ischemia / drug therapy*
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Infarction, Middle Cerebral Artery / complications
  • Infarction, Middle Cerebral Artery / drug therapy*
  • Mechanical Thrombolysis / methods*
  • Tenecteplase / therapeutic use*
  • Treatment Outcome


  • Fibrinolytic Agents
  • Tenecteplase