RT Journal Article
SR Electronic
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
FD BMJ Publishing Group Ltd.
SP jnis-2022-019527
DO 10.1136/jnis-2022-019527
A1 Gaultier Marnat
A1 Stefanos Finistis
A1 Ricardo Moreno
A1 Igor Sibon
A1 Raoul Pop
A1 Mikaël Mazighi
A1 Frédéric Clarençon
A1 Charlotte Rosso
A1 Cyril Dargazanli
A1 Jean Darcourt
A1 Jean-Marc Olivot
A1 Gregoire Boulouis
A1 Kevin Janot
A1 Solène Moulin
A1 Romain Bourcier
A1 Arturo Consoli
A1 Sébastien Richard
A1 Caroline Arquizan
A1 Stephane Vannier
A1 Sebastian Richter
A1 Jean-Christophe Gentric
A1 Chrisanthi Papagiannaki
A1 Olivier Naggara
A1 Omer F Eker
A1 Bertrand Lapergue
A1 Jildaz Caroff
A1 Benjamin Gory
A1 ,
YR 2022
UL http://jnis.bmj.com/content/early/2022/11/10/jnis-2022-019527.abstract
AB 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.