Comparison of three antithrombotic strategies for emergent carotid stenting during stroke thrombectomy: a multicenter study.

Autor:	Pop R; Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France pop.raoul@gmail.com.; Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France.; INSERM, EFS Grand-Est, BPPS UMR-S1255, FMTS, F-67065, University of Strasbourg, Strasbourg, France., Burel J; Radiology, University Hospital Centre Rouen, Rouen, France., Finitsis SN; Neuroradiology, Aristotle University of Thessaloniki, Thessaloniki, Greece., Papagiannaki C; Interventional Neuroradiology, Centre Hospitalier Universitaire de Rouen, Rouen, France., Severac F; Public Healthcare Department, University Hospitals Strasbourg, Strasbourg, France., Mangin PH; INSERM, EFS Grand-Est, BPPS UMR-S1255, FMTS, F-67065, University of Strasbourg, Strasbourg, France., Mihoc D; Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France., Leonard-Lorant I; Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France., Gheoca R; Neurology, University Hospitals Strasbourg, Strasbourg, France., Wolff V; Neurology, University Hospitals Strasbourg, Strasbourg, France., Chibbaro S; Neurosurgery, University Hospitals Strasbourg, Strasbourg, France., Sibon I; Neurology, University Hospital Center Bordeaux, Bordeaux, France., Richard S; Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France., Beaujeux R; Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France., Marnat G; Interventional and Diagnostic Neuroradiology, University Hospital Centre Bordeaux, Bordeaux, France., Gory B; Department of Diagnostic and Interventional Neuroradiology, Centre hospitalier regional universitaire de Nancy, Nancy, France.; Université de Lorraine, Nancy, France.; IADI, INSERM U1254, Nancy, France.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2023 Dec 21; Vol. 15 (e3), pp. e388-e395. Date of Electronic Publication: 2023 Dec 21.
DOI:	10.1136/jnis-2022-019875
Abstrakt:	Background: Periprocedural antithrombotic treatment is a key determinant for the risk-benefit balance of emergent carotid artery stenting (eCAS) during stroke thrombectomy. We aimed to assess the safety and efficacy of three types of antithrombotic treatment. Methods: Retrospective review of prospectively collected endovascular databases in four comprehensive stroke centers, including consecutive cases of eCAS for tandem lesion strokes between January 2019 and July 2021. During this period, each center prospectively applied one of three periprocedural protocols: (a) two centers administered aspirin (250 mg IV); (b) one center administered aspirin and heparin (bolus+24 hours infusion); and (c) one center applied an aggressive antiplatelet strategy consisting of aspirin and clopidogrel (loading doses), with added intravenous tirofiban if in-stent thrombosis was observed during thrombectomy. Dichotomized comparisons of outcomes were performed between aggressive versus non-aggressive strategy (aspirin±heparin) and aspirin+heparin versus aspirin-alone groups. Results: Among 161 included patients, 62 received aspirin monotherapy, 38 aspirin+heparin, and 61 an aggressive treatment. Aggressive antiplatelet treatment was associated with an increased rate of excellent (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) recanalization and reduced carotid stent thrombosis at day 1 (3.5% vs 16.3%), compared with non-aggressive strategy. There were no significant differences in hemorrhagic transformation or 90-day mortality. There was a tendency towards better clinical outcome with aggressive treatment, without reaching statistical significance. Addition of heparin to aspirin was not associated with an increased rate of carotid stent patency. Conclusions: Aggressive antiplatelet treatment was associated with improved intracranial recanalization and carotid stent patency, without safety concerns. These findings have implications for randomized trials and may be of utility for clinicians when making antithrombotic treatment choices. Competing Interests: Competing interests: SNF: patents planned, issued or pending: US11166738B2. IS: consulting fees from Sanofi Synthé-Labo, Servier, Boheringer Ingelheim, Astra-Zeneca, Novonordisk, Medtronic. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Sanofi Synthé-Labo, Medtronic, Boheringer Ingelheim, Astra-Zeneca, BMS-Pfizer. GM: consulting fees from Stryker Neurovascular, Microvention Europe, Balt. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Medtronic, Johnson and Johnson. (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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