Early Recanalization After Intravenous Thrombolysis With Tenecteplase Versus Alteplase in Distal Vessel Occlusion Strokes

The purpose of this monocentric retrospective study is to compare, in patients with acute distal vessel occlusion stroke, the early rates of successful recanalization in patients treated with Alteplase (ALT) versus Tenecteplase (TNK), based on a retrospective analysis of magnetic resonance imaging (MRI) performed early after IVT.

Inclusion Criteria:Age≥ 18 years.Acute ischemic stroke (visible on DWI, but not visible on FLAIR) on initial MRI associated with distal arterial occlusion as defined below:A distal occlusion of the M2 segment of the middle cerebral artery (MCA)Occlusion (regardless of location) of a non-dominant M2 branch of the MCAOcclusion of the M3 segment of the MCA.Occlusion of the A2 or A3 segment of the anterior cerebral artery (ACA)Occlusion of the P2 or P3 branch of the posterior cerebral artery (PCA).A proximal M2-MCA or proximal P1-PCA occlusion may also be included if not eligible for mechanical thrombectomy, especially if the initial NIHSS score is low (<5).Distal arterial occlusion is identified by MRI either on the TOF (Time of Flight)-ARM sequence and/or on the presence of a thrombus (Susceptibility Vessel sign, SVS) on the SWAN sequence,IVT by ALT or TNK within 4H30 after onset of symptoms,Early brain MRI performed 1 to 2 hours after IVT (MRI n°2),Good quality MRI (absence of motion artifact interfering with interpretation) with availability of DWI, FLAIR, TOF-MRA and SWAN sequences.Exclusion Criteria:- Patients informed of the study who objected to the collection of their data.