Increased Rates of Hemorrhages after Endovascular Stroke Treatment with Emergency Carotid Artery Stenting and Dual Antiplatelet Therapy
Autor: | Raveena Singh, Omid Nikoubashman, Arno Reich, Martin Wiesmann, Felix Hadler |
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Rok vydání: | 2021 |
Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Carotid arteries Risk Assessment Risk Factors Internal medicine medicine Humans Carotid Stenosis Thrombolytic Therapy Registries Risk factor Interventional neuroradiology Aged Cerebral Hemorrhage Retrospective Studies Thrombectomy Aged 80 and over Intracerebral hemorrhage business.industry Dual Anti-Platelet Therapy Endovascular Procedures Thrombolysis Tirofiban Middle Aged medicine.disease Stroke Stroke treatment Dissection Treatment Outcome Neurology Cardiology Female Stents Neurology (clinical) Emergencies Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors medicine.drug |
Zdroj: | Cerebrovascular Diseases. 50:162-170 |
ISSN: | 1421-9786 1015-9770 |
Popis: | Background: While endovascular stroke treatment (EST) of large vessel occlusions in acute ischemic stroke (AIS) is proven to be safe and effective, there are subgroups of patients with increased rates of hemorrhages. Our goal was to identify risk factors for intracerebral hemorrhage and to assess whether acute carotid artery stenting (CAS) was associated with increased bleeding rates. Methods: We performed a retrospective analysis of our monocentric prospective stroke registry in the period from May 2010 to May 2018 and compared AIS patients receiving EST with (n = 73) versus without acute CAS (n = 548). Patients with intracranial stents, intra-arterial thrombolysis, or dissection of the carotid artery were excluded. Results: Parenchymal hemorrhage rates (PH2 according to the ECASS classification) and symptomatic hemorrhage (sICH) rates were increased in EST patients receiving CAS with odds being 6.3 (PH2) and 6.5 (sICH) times higher (PH2 17.8 vs. 3.3%, p < 0.001 and sICH: 16.4 vs. 2.9%, p < 0.001). Additional systemic thrombolysis with rtPA (IVRTPA) was no risk factor for cerebral hemorrhage (p = 0.213). Conclusion: AIS patients receiving EST with acute CAS and consecutive tirofiban or dual antiplatelet therapy suffered from an increased risk of relevant secondary intracranial bleeding. After adjusting for confounders, tirofiban and dual antiplatelet therapy were associated with higher bleeding rates. |
Databáze: | OpenAIRE |
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