Abstract WP029: Extending Intravenous Tenecteplase Beyond 4.5-hour in a Community-based Cohort Study

Background: Clinical trial data suggest that treating patients presenting as wake-up stroke or in the 4.5 to 9-hour window from last seen normal (LSN) who meet advanced neuroimaging criteria with intravenous thrombolytic may lead to better functional outcome. We conducted a pilot to assess the logistics of screening and treating these patients with tenecteplase (TNKase) in a large integrated community healthcare system. Methods: Kaiser Permanente Northern California consists of 19 certified primary stroke centers and 2 comprehensive stroke centers serving 4.6+ million members. The region has a standardized Telestroke program that includes video evaluation by a teleneurologist. From 6/1/2023 to 3/31/2025, teleneurologists screened all non-cancelled stroke alerts who met clinical criteria (presenting as wake-up stroke or in the 4.5 to 9-hour window and had baseline mRS 0-2 and NIHSS ≥ 6) with advanced neuroimaging. Those who met advanced neuroimaging criteria (mismatch ratio >1.2, mismatch volume >10mL, and ischemic core volume