Abstract Background and aims Intracranial arterial dolichoectasia (IADE) is a frequent but poorly standardized arteriopathy in acute ischemic stroke. Its reported prevalence varies widely across imaging definitions, and its clinical and safety implications in patients treated with intravenous tenecteplase, with or without mechanical thrombectomy, remain uncertain. We aimed to describe IADE frequency according to complementary imaging definitions and explore associations with clinical characteristics and early outcomes, with a focus on safety. Methods We analyzed consecutive TETRIS patients with available intracranial vascular imaging (n=400). IADE was assessed using complementary approaches, including visual assessment and quantitative arterial measurements. Patients received intravenous tenecteplase and underwent mechanical thrombectomy when indicated. Hemorrhagic transformation, reperfusion grade (TICI), and functional outcome (modified Rankin Scale) were collected. Analyses were descriptive, with exploratory associations. Results IADE frequency varied substantially according to the imaging definition applied. Quantitative arterial enlargement was significantly associated with older age and vascular risk factors, particularly hypertension. Intracranial arterial enlargement showed associations with cervical dolichoectasia and imaging markers of small vessel disease. Importantly, exploratory analyses did not suggest an excess risk of hemorrhagic complications in patients with arterial enlargement after tenecteplase ± thrombectomy. Detailed results will be presented in the presentation. Conclusions In TETRIS, IADE prevalence and clinical associations are highly definition-dependent. Quantitative arterial enlargement appears clinically relevant and, in this cohort, was not associated with an obvious hemorrhagic safety signal after tenecteplase ± thrombectomy. These findings support the need for standardised IADE criteria and dedicated outcome studies. Conflict of interest nothing to disclose
Laroussi et al. (Fri,) studied this question.