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Original research
Aspirin versus aggressive antiplatelet therapy for acute carotid stenting plus thrombectomy in tandem occlusions: ETIS Registry results
  1. Gaultier Marnat1,
  2. Stefanos Finistis2,
  3. Ricardo Moreno3,
  4. Igor Sibon4,
  5. Raoul Pop5,
  6. Mikaël Mazighi6,7,
  7. Frédéric Clarençon8,9,
  8. Charlotte Rosso10,
  9. Cyril Dargazanli11,
  10. Jean Darcourt12,
  11. Jean-Marc Olivot13,
  12. Gregoire Boulouis14,
  13. Kevin Janot14,
  14. Solène Moulin15,
  15. Romain Bourcier16,
  16. Arturo Consoli17,
  17. Sébastien Richard18,
  18. Caroline Arquizan19,
  19. Stephane Vannier20,
  20. Sebastian Richter21,
  21. Jean-Christophe Gentric22,
  22. Chrisanthi Papagiannaki23,
  23. Olivier Naggara24,
  24. Omer F Eker25,
  25. Bertrand Lapergue26,
  26. Jildaz Caroff27,
  27. Benjamin Gory28
  28. on behalf of the ETIS Registry Investigators
  1. 1 Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, France
  2. 2 Neurosurgery, Aristotle University of Thessaloniki, Thessaloniki, Central Macedonia, Greece
  3. 3 Neuroradiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
  4. 4 Neurology, CHU de Bordeaux, Bordeaux, France
  5. 5 Neuroradiolology, CHU Strasbourg, Strasbourg, France
  6. 6 Interventional Neuroradiology, Fondation Rothschild, Paris, France
  7. 7 Neurology, GH Lariboisiere Fernand-Widal, Paris, France
  8. 8 Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France
  9. 9 Sorbonne University, Paris, France
  10. 10 Neurology, Hopital Universitaire Pitie Salpetriere, Paris, France
  11. 11 Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
  12. 12 Neuroradiology, CHU Toulouse, Toulouse, France
  13. 13 Neurology, CHU Toulouse, Toulouse, France
  14. 14 Neuroradiology, CHRU Tours, Tours, France
  15. 15 Neurology, University Hospital Centre Reims, Reims, France
  16. 16 Neuroradiology, Université de Nantes, Nantes, France
  17. 17 Neuroradiology, Hopital Foch, Suresnes, France
  18. 18 Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
  19. 19 Neurology, CHU Montpellier, Montpellier, France
  20. 20 Neurology, CHU Rennes, Rennes, France
  21. 21 Neuroradiology, CH Pau, Pau, France
  22. 22 Neuroradiology, CHU Brest, Brest, France
  23. 23 Neuroradiology, CHU Rouen, Rouen, France
  24. 24 Neuroradiology, Saint Anne Hospital Centre, Paris, France
  25. 25 Neuroradiology, Hospices Civils de Lyon, Bron, France
  26. 26 Stroke Center Neurology Division, Hopital Foch, Suresnes, France
  27. 27 Interventional Neuroradiology, NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
  28. 28 Diagnostic and Interventional Neuroradiology, Centre Hospitalier Universitaire de Nancy, Nancy, France
  1. Correspondence to Dr Gaultier Marnat, Interventional and Diagnostic Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux 33076, Aquitaine, France; gaultier.marnat{at}


Background Patients treated with acute carotid stenting (CAS) may have higher odds of a favorable outcome than those treated without CAS during thrombectomy in tandem occlusions. Antiplatelet therapy is associated with CAS to avoid stent thrombosis, which occurs in around 20% of patients and negatively impacts outcomes. In this study we compared two antiplatelet strategies in tandem occlusion strokes treated with CAS and intracranial thrombectomy in clinical practice.

Methods The Endovascular Treatment in Ischemic Stroke Registry is an ongoing prospective observational study involving 21 comprehensive stroke centers performing thrombectomy in France. We analyzed patients with atherosclerotic tandem occlusions treated with acute CAS and intracranial thrombectomy who received at least one antiplatelet agent. Aggressive antiplatelet therapy included oral or intravenous glycoprotein (GP) IIb/IIIa or P2Y12 inhibitors. The primary outcome was cervical carotid artery patency at day 1 imaging follow-up.

Results Among the 187 included patients, 124 (66.3%) received aspirin alone and 63 (33.7%) received aggressive antiplatelet therapy. There was no significant difference regarding safety outcomes, especially in symptomatic intracerebral hemorrhage, parenchymal hematoma, and procedural complications. There was a significantly higher rate of carotid stent patency at day 1 in the aggressive antiplatelet therapy group (81.7% vs 97.1%, aOR 17.49, 95% CI 1.10 to 277.2, p=0.042). Odds of favorable functional outcome (90-day modified Rankin Scale score 0–2) were similar between the groups (OR 3.04, 95% CI 0.64 to 14.25, p=0.158).

Conclusions In tandem occlusions treated with CAS plus thrombectomy, an aggressive antiplatelet regimen was associated with an increased rate of carotid stent patency at day 1 without safety concerns. Randomized trials are warranted to confirm these findings.

  • Stroke
  • Stent
  • Atherosclerosis
  • Thrombectomy
  • Platelets

Data availability statement

Data are available upon reasonable request. The data used in this study are available from the corresponding author upon reasonable request.

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Data availability statement

Data are available upon reasonable request. The data used in this study are available from the corresponding author upon reasonable request.

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  • Contributors All authors have read and approved the submitted manuscript and confirm that the manuscript has not been submitted elsewhere or published elsewhere in whole or in part. All authors have made substantial contributions and have approved the final submitted version. GM is responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.