Thrombolysis in acute ischemic stroke remains the only effective treatment. Alteplase or recombinant tissue Plasminogen Activator (rt-PA) is the only drug approved and widely used. The use of tenecteplase is still studied [1, 2]. In sub-Saharan Africa, many patients, although eligible for thrombolysis, do not benefit for many reasons including accessibility to medical imaging, the lack of stroke unit, and the cost of thrombolytic drug. We report the first Congolese case of intravenous thrombolysis, using tenecteplase.
It was a 49-year-old man, with history of hypertension, who has presented suddenly a left hemiplegia and speech difficulties. The National Institute of Health Stroke Score (NIHSS) was 18. The Computed Tomography (CT) scan was normal and no hemostatic abnormality. Thrombolysis was indicated and performed by a neurologist at 2 h and 48 min with 0·1 mg/kg of tenecteplase. The CT scan performed at 24 h did not show bleeding.
Thrombolysis in cerebral vascular accident has never been done in the Congo. Our case presents a double interest, thrombolysis outside a stroke unit, and the use of tenecteplase. It can be performed outside of a stroke unit but requires at least a medical expertise. As Parsons et al. [1, 2] reported in their series, there is a significant improvement in NIHSS score at 24 h after use of tenecteplase compared with rt-PA. The initial CT scan of our patient was normal. In the series of Mejdoubi et al.  of 30 patients, nine had a normal scan; Schellinger et al.  reported that the sensitivity of CT in detecting early signs varies from 31% to 71%. Bleeding after thrombolysis is less frequent with tenecteplase than alteplase .
Thrombolysis can be achieved in sub-Saharan Africa, with minimum conditions. The tenecteplase can be used in stroke, a dose of 0·1 mg/kg seems to be adapted, but more studies are needed to better assess the effective dose and tolerance.