Antiplatelet Therapy During Emergent Extracranial Internal Carotid Artery Stenting: Comparison of Three Intravenous Antiplatelet Perioperative Strategies.

Autor: Delvoye F; Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Université de Liège, Belgique. Electronic address: fdelvoye@for.paris., Maier B; Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France. Electronic address: bmaier@for.paris., Escalard S; Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France. Electronic address: sescalard@for.paris., Labreuche J; University of Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000 Lille, France. Electronic address: julien.labreuche.chru@gmail.com., Thion LA; Anesthesiology Department, Rothschild Foundation Hospital, Paris, France. Electronic address: lathion@for.paris., Aknouche S; Clinical Research Unit, Rothschild Foundation Hospital, Paris, France. Electronic address: saknouche@for.paris., Hebert S; Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France. Electronic address: shebert@for.paris., Redjem H; Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France. Electronic address: hredjem@for.paris., Smajda S; Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France. Electronic address: ssmajda@for.paris., Ciccio G; Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France. Electronic address: gciccio@for.paris., Allard J; Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France. Electronic address: jallard@for.paris., Sabben C; Neurology Department, Rothschild Foundation Hospital, Paris, France. Electronic address: csabben@for.paris., Obadia M; Neurology Department, Rothschild Foundation Hospital, Paris, France. Electronic address: mobadia@for.paris., Maertens de Noordhout A; Université de Liège, Belgique. Electronic address: alain.maertens@chrcitadelle.be., Olivot JM; Neurology Department, CHU Toulouse, Toulouse, France. Electronic address: jmolivot@gmail.com., Blanc R; Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France. Electronic address: rblanc@for.paris., Piotin M; Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France. Electronic address: mpiotin@for.paris., Desilles JP; Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France; Université de Paris, France. Electronic address: jpdesilles@for.paris., Mazighi M; Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France; Université de Paris, France; FHU Neurovasc, France. Electronic address: mmazighi@for.paris.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2021 Feb; Vol. 30 (2), pp. 105521. Date of Electronic Publication: 2020 Dec 09.
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105521
Abstrakt: Introduction: Guidelines for antiplatelet therapy administration, during emergent stenting for extra-cranial internal carotid artery (EC-ICA) occlusion in the setting of acute ischemic stroke (AIS) are lacking. Different antiplatelet regimen are used in association to endovascular therapy (EVT) for the treatment of EC-ICA lesions. We aimed to compare the clinical and radiological effects of three intravenous antiplatelet agents used during emergent EC-ICA stenting.
Material and Methods: Clinical data were collected from January 2015 to December 2019 in a monocentric prospective registry of AIS patients treated by EVT. All patients who underwent emergent EC-ICA stenting were sorted regarding the intravenous antiplatelet agent used during the procedure.
Results: Among 218 patients treated by EVT for an EC-ICA occlusion of the anterior circulation during the study period, 70 underwent an emergent stenting of the EC-ICA. 60 were included in the present study, 9 received intravenous (IV) Cangrelor, 8 IV abciximab and 43 Aspirin. The rate of favorable neurological outcome, defined as modified Rankin Scale (mRS) ≤ 2 at three months were better in the Cangrelor and Aspirin groups (66,7% and 58,1%, respectively) than in the Abciximab group (37,5%), as well as, the rate of any intracranial ICH (22,2% and 37,2% vs 62,5%). The rate of acute stent reocclusion was similar between groups.
Conclusion: When used as a rescue treatment during emergent stenting of EC-ICA, Cangrelor and Aspirin present a better safety profile than Abciximab, with less intracranial hemorrhages and a higher rate of good clinical outcome. Additional studies are needed to confirm these findings.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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