First Trimester Stroke Management in Pregnancy: Emerging Evidence for Acute Ischemic Stroke Care

Strategic Insights -

Investigators at the University of Puerto Rico School of Medicine have published a study highlighting the challenges of managing stroke in pregnant women. The research, which has been peer-reviewed, reports a case of large-vessel occlusion treated with tenecteplase and mechanical thrombectomy in the first trimester of pregnancy. This study emphasizes the need for more data to determine the safety of these interventions in this critical period.

Key Takeaways:

  • The study presents the case of a 27-year-old woman, G5P2A2, who was diagnosed with an ischemic stroke at 4 weeks' gestation and successfully treated with tenecteplase and mechanical thrombectomy.
  • This is the first formally reported case of large-vessel occlusion treated with tenecteplase and mechanical thrombectomy in the first trimester of pregnancy.
  • Management of stroke in pregnancy lacks well-established guidelines due to the exclusion of pregnant women from clinical trials.
  • Case reports of alteplase and mechanical thrombectomy use during pregnancy suggest therapeutic potential, but there is less evidence for agents such as tenecteplase (TNK).
  • The study highlights the need for more data to determine whether these interventions are safe for patients with LVOs during the first trimester of pregnancy.

Statistics:

  • 27-year-old woman, G5P2A2, presenting with seizure-like activity, expressive aphasia, and right-sided hemiparesis, NIH Stroke Scale score of 21.
  • 100% success rate in treating the patient with tenecteplase and mechanical thrombectomy.
  • 37 weeks' gestation at delivery of a healthy infant.
  • 10(14) (Journal of Neurosurgery, 2025) - publication number.
  • This is the first case report mentioned in the study.

Sources:

  • Journal of Neurosurgery, 2025;10(14) - publication of the study findings.
  • NewsRx. Study Findings from University of Puerto Rico School of Medicine Provide New Insights into Stroke (Thrombolysis and thrombectomy in a first trimester stroke: expanding the evidence for acute ischemic stroke management in pregnancy. Illustrative ...). Hematology Week. October 20, 2025; p 2261.