R Pop1,2, A Hasiu3, P H Mangin4, F Severac5, D Mihoc3, D Nistoran3, M Manisor3, M Simu6, S Chibbaro7, R Gheoca8, V Quenardelle8, O Rouyer8, V Wolff8, R Beaujeux3,2. 1. From the Interventional Neuroradiology Department (R.P., A.H., D.M., D.N., M.M., R.B.), Strasbourg University Hospitals, Strasbourg, France pop.raoul@gmail.com. 2. Institut de Chirurgie Minime Invasive Guidée par l'Image (R.P., R.B.), Strasbourg, France. 3. From the Interventional Neuroradiology Department (R.P., A.H., D.M., D.N., M.M., R.B.), Strasbourg University Hospitals, Strasbourg, France. 4. Institut National de la Santé et de la Recherche Médicale (P.H.M.), University of Strasbourg, l'Établissement français du sang Grand-Est, BPPS UMR-S1255, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France. 5. Public Healthcare Department (F.S.), Strasbourg University Hospitals, Strasbourg, France. 6. Neurology Department (M.S.), Victor Babes University of Medicine and Pharmacy, Timisoara, Romania. 7. Neurosurgery Department (S.C.), Strasbourg University Hospitals, Strasbourg, France. 8. Stroke Unit (R.G., V.Q., O.R., V.W.), Strasbourg University Hospitals, Strasbourg, France.
Abstract
BACKGROUND AND PURPOSE: Postprocedural dual-antiplatelet therapy is frequently withheld after emergent carotid stent placement during stroke thrombectomy. We aimed to assess whether antiplatelet regimen variations increase the risk of stent thrombosis beyond postprocedural day 1. MATERIALS AND METHODS: Retrospective review was undertaken of all consecutive thrombectomies for acute stroke with tandem lesions in the anterior circulation performed in a single comprehensive stroke center between January 9, 2011 and March 30, 2020. Patients were included if carotid stent patency was confirmed at day 1 postprocedure. The group of patients with continuous dual-antiplatelet therapy from day 1 was compared with the group of patients with absent/discontinued dual-antiplatelet therapy. RESULTS: Of a total of 109 tandem lesion thrombectomies, 96 patients had patent carotid stents at the end of the procedure. The early postprocedural stent thrombosis rate during the first 24 hours was 14/96 (14.5%). Of 82 patients with patent stents at day 1, in 28 (34.1%), dual-antiplatelet therapy was either not initiated at day 1 or was discontinued thereafter. After exclusion of cases without further controls of stent patency, there was no significant difference in the rate of subacute/late stent thrombosis between the 2 groups: 1/50 (2%) in patients with continuous dual-antiplatelet therapy versus 0/22 (0%) in patients with absent/discontinued dual-antiplatelet therapy (P = 1.000). In total, we observed 88 patient days without any antiplatelet treatment and 471 patient days with single antiplatelet treatment. CONCLUSIONS: Discontinuation of dual-antiplatelet therapy was not associated with an increased risk of stent thrombosis beyond postprocedural day 1. Further studies are warranted to better assess the additional benefit and optimal duration of dual-antiplatelet therapy after tandem lesion stroke thrombectomy.
BACKGROUND AND PURPOSE: Postprocedural dual-antiplatelet therapy is frequently withheld after emergent carotid stent placement during stroke thrombectomy. We aimed to assess whether antiplatelet regimen variations increase the risk of stent thrombosis beyond postprocedural day 1. MATERIALS AND METHODS: Retrospective review was undertaken of all consecutive thrombectomies for acute stroke with tandem lesions in the anterior circulation performed in a single comprehensive stroke center between January 9, 2011 and March 30, 2020. Patients were included if carotid stent patency was confirmed at day 1 postprocedure. The group of patients with continuous dual-antiplatelet therapy from day 1 was compared with the group of patients with absent/discontinued dual-antiplatelet therapy. RESULTS: Of a total of 109 tandem lesion thrombectomies, 96 patients had patent carotid stents at the end of the procedure. The early postprocedural stent thrombosis rate during the first 24 hours was 14/96 (14.5%). Of 82 patients with patent stents at day 1, in 28 (34.1%), dual-antiplatelet therapy was either not initiated at day 1 or was discontinued thereafter. After exclusion of cases without further controls of stent patency, there was no significant difference in the rate of subacute/late stent thrombosis between the 2 groups: 1/50 (2%) in patients with continuous dual-antiplatelet therapy versus 0/22 (0%) in patients with absent/discontinued dual-antiplatelet therapy (P = 1.000). In total, we observed 88 patient days without any antiplatelet treatment and 471 patient days with single antiplatelet treatment. CONCLUSIONS: Discontinuation of dual-antiplatelet therapy was not associated with an increased risk of stent thrombosis beyond postprocedural day 1. Further studies are warranted to better assess the additional benefit and optimal duration of dual-antiplatelet therapy after tandem lesion stroke thrombectomy.
Authors: Fabrizio D'Ascenzo; Mario Bollati; Fabrizio Clementi; Davide Castagno; Bo Lagerqvist; Jose M de la Torre Hernandez; Juriën M ten Berg; Bruce R Brodie; Philip Urban; Lisette Okkels Jensen; Gabriel Sardi; Ron Waksman; John M Lasala; Stefanie Schulz; Gregg W Stone; Flavio Airoldi; Antonio Colombo; Gilles Lemesle; Robert J Applegate; Piergiovanni Buonamici; Ajay J Kirtane; Anetta Undas; Imad Sheiban; Fiorenzo Gaita; Giuseppe Sangiorgi; Maria Grazia Modena; Giacomo Frati; Giuseppe Biondi-Zoccai Journal: Int J Cardiol Date: 2012-02-22 Impact factor: 4.164
Authors: B Gory; D C Haussen; M Piotin; H Steglich-Arnholm; M Holtmannspötter; J Labreuche; M Kyheng; C Taschner; S Eiden; R G Nogueira; P Papanagiotou; M Boutchakova; A H Siddiqui; B Lapergue; F Dorn; C Cognard; M Killer; S Mangiafico; M Ribo; M N Psychogios; A M Spiotta; M A Labeyrie; A Biondi; M Mazighi; F Turjman Journal: Eur J Neurol Date: 2018-04-16 Impact factor: 6.089
Authors: Marta Rubiera; Marc Ribo; Raquel Delgado-Mederos; Esteban Santamarina; Pilar Delgado; Joan Montaner; José Alvarez-Sabín; Carlos A Molina Journal: Stroke Date: 2006-08-03 Impact factor: 7.914
Authors: Panagiotis Papanagiotou; Diogo C Haussen; Francis Turjman; Julien Labreuche; Michel Piotin; Andreas Kastrup; Henrik Steglich-Arnholm; Markus Holtmannspötter; Christian Taschner; Sebastian Eiden; Raul G Nogueira; Maria Boutchakova; Adnan Siddiqui; Bertrand Lapergue; Franziska Dorn; Christophe Cognard; Monika Killer; Salvatore Mangiafico; Marc Ribo; Marios N Psychogios; Alejandro Spiotta; Marc Antoine Labeyrie; Alessandra Biondi; Mikaël Mazighi; Sébastien Richard; René Anxionnat; Serge Bracard; Benjamin Gory Journal: JACC Cardiovasc Interv Date: 2018-07-09 Impact factor: 11.195
Authors: L Legrand; M Tisserand; G Turc; O Naggara; M Edjlali; C Mellerio; J-L Mas; J-F Méder; J-C Baron; C Oppenheim Journal: AJNR Am J Neuroradiol Date: 2014-09-04 Impact factor: 3.825
Authors: Henrik Steglich-Arnholm; Markus Holtmannspötter; Daniel Kondziella; Aase Wagner; Trine Stavngaard; Mats E Cronqvist; Klaus Hansen; Joan Højgaard; Sarah Taudorf; Derk Wolfgang Krieger Journal: J Neurol Date: 2015-09-07 Impact factor: 4.849
Authors: Marta Wallocha; René Chapot; Hannes Nordmeyer; Jens Fiehler; Ralph Weber; Christian Paul Stracke Journal: Front Neurol Date: 2019-02-27 Impact factor: 4.003