Effect of Antiplatelet Therapy in Acute Ischemic Stroke with Tandem Lesions
Mudassir Farooqui1, Milagros Galecio-Castillo2, Afshin Divani3, Amer Malik4, Nils Petersen5, Michael Abraham6, Johanna Fifi7, Waldo Guerrero8, James Siegler9, Thanh Nguyen10, Sunil Sheth11, Albert Yoo12, Guillermo Linares13, Nazli Janjua14, Syed Zaidi15, Jessica Kobsa5, Ayush Prasad16, Asad Ikram17, Cynthia Zevallos1, Darko Quispe Orozco18, Manual Requena19, Marta Olive Gadea20, Abid Qureshi21, Tiffany Barkley22, Andres Dajles1, Stavros Matsoukas23, Ameena Rana24, Mohamad Abdalkader10, Sergio Marioni25, Jazba Soomro12, Juan Vivanco-Suarez1, Randall Edgell13, Maxim Mokin26, Dileep Yavagal4, Mouhammad Jumaa15, Ameer Hassan27, Santiago Ortega-Gutierrez1
1University of Iowa, 2University of Iowa Hospitals and Clinics, 3University of New Mexico, 4University of Miami Miller School of Medicine, 5Yale University, 6The University of Kansas Health System, 7Mount Sinai Hospital, 8University of South Florida College of Medicine, 9Cooper University Hospital, 10Boston Medical Center, 11University of Texas At Houston, 12Texas Stroke Institute, 13St Louis University, 14Pomona valley, 15ProMedica Stroke Network, 16Yale School of Medicine & Yale - New Haven Hospital, 17Harvard Medical School/ Beth Israel Deaconess Medical Center, 18TTUHSC-SOM, Lubbock; Neurology Dept., 19Vall de Hebron, 20Vall de hebron, 21Kansas Medical Center, 22University of Kansas, 23Mt Sinai, 24Cooper, 25University of Texas, 26University of South Florida, 27Valley Baptist Medical Center
Objective:
To evaluate the effect of antiplatelet therapy in patients with acute ischemic stroke (AIS) with tandem lesion
Background:
Carotid artery stenting (CAS) is beneficial in acute ischemic stroke patients with tandem lesions (TL). However, stent placement requires the use of antiplatelet medications to prevent in-stent thrombosis and re-occlusion of the artery. This must be balanced with the risk of intracerebral hemorrhage.
Design/Methods:
It is a multicenter study from 17 centers and included patients with intracranial occlusion of ICA or M1/M2 segment of MCA with a concomitant extracranial ICA occlusion or stenosis ≥50%. Inclusion criteria were; age ≥18 years, EVT for intracranial occlusion, and underwent treatment for extracranial ICA lesions. Patients were divided into groups according to the number of antiplatelets administered at the time of endovascular therapy (EVT) procedure. Multivariable logistic regression models with multiple imputations were built to assess the association of primary outcome; symptomatic intracranial hemorrhage (sICH), and secondary outcomes; modified Rankin Score (mRS) 0-2 at 90 days, and successful reperfusion (mTICI score ≥2b)
Results:
A total of 623 patients were included. Of these, 126 (20.2%) did not receive any antiplatelet therapy, 129 (20.7%) were treated with single oral, 174 (27.9%) with dual oral, and 194 (31.1%) with intravenous combined with single or dual antiplatelets. Rate of favorable outcome was non-significantly higher in the dual (52.2%) and IV-combination (52.7%), as compared with single (38.8%) and without antiplatelet (34.7%) medications. Successful reperfusion (mTICI score ≥2b) was significantly higher in dual oral and IV-combination antiplatelets (single: aOR: 1.0, CI: 0.52-1.62, p=0.99, dual: aOR: 3.45, CI: 1.52-7.84, p=0.003, IV-combination: aOR: 2.76, CI: 1.29-5.9, p=0.009). No significant differences in the sICH and functional outcome at 90 days.
Conclusions:
Administration of antiplatelet medications during EVT was associated with successful reperfusion without increasing the rate of symptomatic hemorrhage in patients with anterior circulation LVO with TLs.