Aspirin versus aggressive antiplatelet therapy for acute carotid stenting plus thrombectomy in tandem occlusions: ETIS Registry results

• Published in: Journal of neurointerventional surgery Vol. 15; no. e2; pp. e248 - e254
• Main Authors: Marnat, Gaultier, Finistis, Stefanos, Moreno, Ricardo, Sibon, Igor, Pop, Raoul, Mazighi, Mikaël, Clarençon, Frédéric, Rosso, Charlotte, Dargazanli, Cyril, Darcourt, Jean, Olivot, Jean-Marc, Boulouis, Gregoire, Janot, Kevin, Moulin, Solène, Bourcier, Romain, Consoli, Arturo, Richard, Sébastien, Arquizan, Caroline, Vannier, Stephane, Richter, Sebastian, Gentric, Jean-Christophe, Papagiannaki, Chrisanthi, Naggara, Olivier, Eker, Omer F, Lapergue, Bertrand, Caroff, Jildaz, Gory, Benjamin
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.11.2023; BMJ Publishing Group LTD; BMJ Journals
• Subjects: Aspirin; Atherosclerosis; Carotid arteries; Carotid Stenosis / complications; Endovascular Procedures / methods; Hemorrhage; Humans; Ischemia; Ischemic stroke; Ischemic Stroke / etiology; Life Sciences; Patients; Platelet Aggregation Inhibitors / therapeutic use; Platelets; Registries; Retrospective Studies; Stent; Stents; Stents / adverse effects; Stroke; Stroke / diagnostic imaging; Stroke / drug therapy; Stroke / surgery; Thrombectomy; Thrombectomy / methods; Thrombosis; Treatment Outcome; Veins & arteries; France; Thrombectomy; Stroke; Platelets; Stent; Atherosclerosis
• ISSN: 1759-8478; 1759-8486; 1759-8486
• DOI: 10.1136/jnis-2022-019527

BackgroundPatients 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.MethodsThe 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.ResultsAmong 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).ConclusionsIn 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.