Transition to tenecteplase is associated with shorter door-to-puncture times: a retrospective study from the Lone Star Stroke consortium TNK registry

Background Intravenous thrombolytic (IVT) and mechanical thrombectomy (MT) 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 (DTN) and door-to-puncture (DTP) times. Tenecteplase (TNK) offers potential advantages over alteplase (ALT), including a simplified one-time bolus administration, which may reduce DTP time. Results suggest TNK is non-inferior to ALT in terms of clinical outcomes, but few large cohort studies have compared DTP time for patients receiving TNK vs. ALT prior to thrombectomy. This real-world study aimed to compare DTP times and discharge outcomes in patients treated with TNK vs. ALT before thrombectomy. Methods Retrospective data were collected from three comprehensive stroke centers (CSCs) in Texas from October 2019 to November 2024 and included subjects that received both IVT and MT. Data were analyzed for DTP times and other time metrics. Results Among 50 ALT and 89 TNK patients in our study cohort, the TNK group had significantly shorter DTP times of 80 min (62–96) compared to ALT times of 101.5 min (80–121), P 0.001. No significant differences were found for door-to-imaging and imaging-to-needle times; however, needle-to-puncture times were significantly shorter with TNK 39 min (29–51) compared to ALT 55 min (43–77), P 0.001. Both groups had similar favorable outcomes at discharge. Conclusions Our Lone Star Stroke (LSS) TNK registry represents the real-world experience of academic CSCs in Texas. We demonstrated that transitioning to TNK is associated with shorter DTP times compared to ALT. These results are primarily due to shorter needle-to-puncture times and may be attributable to TNK's simplified single-bolus administration. Both TNK and ALT groups demonstrated high rates of favorable outcomes at discharge, but given its faster DTP time, TNK is likely a preferable option for LVO stroke patients requiring both IVT and MT.