Abstract Number: Esoc2026a1837 Impact of Recanalization Status and Onset-to-Recanalisation Time on the Risk of Parenchymal Hemorrhage Among Stroke Patients Treated With Tenecteplase and Intended for Thrombectomy

Abstract Background and aims Parenchymal hemorrhage (PH) is a major complication of reperfusion therapies in patients with large vessel occlusion (LVO) stroke, being strongly associated with poor functional outcome. Previous studies have suggested an increased risk of PH with longer onset-to- recanalization times (OTR). We aimed to evaluate the association between PH, recanalization status, and OTR in patients treated with intravenous tenecteplase and intended for endovascular thrombectomy (TNK+EVT). Methods We conducted a retrospective analysis of the TETRIS registry including consecutive LVO stroke patients treated with TNK+EVT and with available 24-hour follow-up brain imaging. Recanalization status was classified as: early recanalization (ER) prior to EVT; successful post- EVT recanalization (mTICI 2b–3); and no recanalization (mTICI 0–2a). PH rates were compared across recanalization groups. Among recanalized patients, the association between OTR and PH was assessed using multivariable logistic regression. Results A total of 930 patients were included: 186 (20%) achieved ER, 624 (67%) had post-EVT recanalization, and 120 (13%) had no recanalization. PH occurred in 118 patients (12.7%): 21 (11.3%) in the ER group, 86 (13.8%) in the post-EVT recanalization group, and 11 (9.2%) in the no-recanalization group. After adjustment for baseline NIHSS and ASPECTS, PH rates did not differ significantly across recanalization categories (P=0.44). Among recanalized patients, OTR was not independently associated with PH risk (aOR/60-minute : 1.04, 95% CI 0.91–1.20; P=0.57). Conclusions Among patients treated with TNK + EVT in routine care, neither recanalization status nor OTR among recanalized patients was significantly associated with the occurrence of PH. Conflict of interest Clémence Dimnet : no disclosure. Jean-Marc Olivot : consulting fees from Abbvie, Roche, and Boehringer; support for attending meetings and travel from Boehringer; and participation in the data and safety monitoring board of the DIRECT-ANGIO trial and NETS TARGET Study. Guillaume Turc : lecturing fees from Guerbet France, consulting fees for Neurologica and AI-Stroke Nicolas Chausson : no disclosure. Stéphane Olindo : no disclosure. Gaultier Marnat : consulting fees from Stryker neurovascular, Microvention Europe (Terumo Neuro), Balt Extrusion, Sim and Cure and paid lectures for Medtronic, Wallaby Phenox, Bracco, Penumbra and Johnson funding from the Programme hospitalier de recherche Clinique, Boehringer Ingelheim and the DMU Neurosciences of APHP.Sorbonne Université. Gaspard Gerschenfeld : consulting fees from Truffle Capital, funding from the Programme hospitalier de recherche Clinique, Boehringer Ingelheim and the DMU Neurosciences of APHP.Sorbonne Université. Figure 1 - belongs to Results