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P164/236  Antithrombotic regimen in emergent carotid stenting for acute ischemic stroke due to tandem lesion: a meta-analysis of aggregate data
  1. Francesco Diana1,
  2. Mohamad Abdalkader2,
  3. Daniel Behme3,
  4. Wei Li4,
  5. Christoph J Maurer5,
  6. Raoul Pop6,
  7. Yang-Ha Hwang7,
  8. Bruno Bartolini8,
  9. Valerio Da Ros9,
  10. Sandra Bracco10,
  11. Luigi Cirillo11,
  12. Gaultier Marnat12,
  13. Aristeidis Katsanos13,
  14. Johannes Kaesmacher14,
  15. Urs Fischer14,
  16. Diana Aguiar de Sousa15,
  17. Simone Peschillo16,
  18. Andrea Zini17,
  19. Alejandro Tomasello1,
  20. Marc Ribo18,
  21. Thanh N Nguyen19,
  22. Michele Romoli20
  1. 1Interventional Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Catalunya, Spain, Barcelona, Spain
  2. 2Boston Medical Center, Radiology, Boston, USA
  3. 3Neuroradiology, University Hospital Magdeburg, Magdeburg, Sachsen-Anhalt, Germany, Sachsen-Ahalt, Germany
  4. 4Neurology, Hainan Medical University, Haikou, Hainan, China, Hainan, China
  5. 5Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Bayern, Germany, Bayern, Germany
  6. 6Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France, Strasbourg, France
  7. 7Neurology and Radiology, Kyungpook National University Hospital, Daegu, Korea (the Republic of), Daegu, Korea, Dem. People?s Rep. of
  8. 8Diagnostic and Interventional Radiology, Interventional Neuroradiology Unit, CHUV – Lausanne University Hospital, Lausanne, Switzerland, Lausanne, Switzerland
  9. 9Biomedicine and Prevention, Diagnostic Imaging Unit, Fondazione PTV Policlinico Tor Vergata, Roma, Italy, Rome, Italy
  10. 10Neurology and Human Movement Sciences, Interventional Neuroradiology Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy, Siena, Italy
  11. 11Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy, Bologna, Italy
  12. 12Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France, Bordeaux, France
  13. 13Neurology Division, McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada, Ontario, Canada
  14. 14Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland, Bern, Switzerland
  15. 15Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria/CHULN, University of Lisbon, Lisboa, Portugal, Lisboa, Portugal
  16. 16UniCamillus International Medical University, Rome, Italy, Rome, Italy
  17. 17Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Emilia-Romagna, Italy, Bologna, Italy
  18. 18Stroke Unit, Neurology, Vall d’Hebron University Hospital, Barcelona, Spain, Barcelona, Spain
  19. 19Neurology, Boston University School of Medicine, Boston, Massachusetts, USA, Boston, USA
  20. 20Neurology and Stroke Unit, Maurizio Bufalini Hospital, Cesena, Emilia-Romagna, Italy, Cesena, Italy


Background The periprocedural antithrombotic regimen might affect the risk-benefit profile of emergent carotid artery stenting (eCAS) in patients with acute ischemic stroke (AIS) due to tandem lesions, especially after intravenous thrombolysis. We conducted a systematic review and meta-analysis to evaluate the safety and efficacy of antithrombotics following eCAS.

Methods We followed PRISMA guidelines and searched MEDLINE, Embase, and Scopus from January 1, 2004 to November 30, 2022 for studies evaluating eCAS in tandem occlusion. The primary endpoint was 90-day good functional outcome. Secondary outcomes were symptomatic intracerebral hemorrhage, in-stent thrombosis, delayed stent thrombosis, and successful recanalization. Meta-analysis of proportions and meta-analysis of odds ratios were implemented.

Results 34 studies with 1658 patients were included. We found that the use of no-antiplatelets (noAPT), single antiplatelet (SAPT), dual antiplatelets (DAPT), or glycoprotein IIb/IIIa inhibitors (GPI) yielded similar rates of good functional outcomes, with a marginal benefit of GPI over SAPT. Results excluded a significant impact of intravenous thrombolysis and ASPECTS. We observed no increase in symptomatic intracerebral hemorrhage (sICH) with DAPT or GPI compared with noAPT or SAPT. We found similar rates of delayed stent thrombosis across groups, with acute in-stent thrombosis showing marginal benefits from GPI and DAPT over SAPT and noAPT.

Conclusions In AIS due to tandem occlusion, the periprocedural antithrombotic regimen of eCAS seems to have a marginal effect on good functional outcome. Overall, high intensity antithrombotic therapy may provide a marginal benefit on good functional outcome and carotid stent patency without a significant increase in risk of sICH.

Disclosure of Interest Nothing to disclose

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