TY - JOUR T1 - Aspirin versus aggressive antiplatelet therapy for acute carotid stenting plus thrombectomy in tandem occlusions: ETIS Registry results JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg DO - 10.1136/jnis-2022-019527 SP - jnis-2022-019527 AU - Gaultier Marnat AU - Stefanos Finistis AU - Ricardo Moreno AU - Igor Sibon AU - Raoul Pop AU - Mikaël Mazighi AU - Frédéric Clarençon AU - Charlotte Rosso AU - Cyril Dargazanli AU - Jean Darcourt AU - Jean-Marc Olivot AU - Gregoire Boulouis AU - Kevin Janot AU - Solène Moulin AU - Romain Bourcier AU - Arturo Consoli AU - Sébastien Richard AU - Caroline Arquizan AU - Stephane Vannier AU - Sebastian Richter AU - Jean-Christophe Gentric AU - Chrisanthi Papagiannaki AU - Olivier Naggara AU - Omer F Eker AU - Bertrand Lapergue AU - Jildaz Caroff AU - Benjamin Gory A2 - , Y1 - 2022/11/10 UR - http://jnis.bmj.com/content/early/2022/11/10/jnis-2022-019527.abstract N2 - 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.Data are available upon reasonable request. The data used in this study are available from the corresponding author upon reasonable request. ER -