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Abstract Details

Antiplatelet Therapy in Patients Receiving Emergent Carotid Stenting After Intravenous Thrombolysis: A Multicenter Retrospective Matched Analysis
Cerebrovascular Disease and Interventional Neurology
P1 - Poster Session 1 (8:00 AM-9:00 AM)

Tandem occlusions are frequent and may lead to major stroke and unfavorable outcome, however their management remains controversial. One of the main concerns is the risk of intracerebral hemorrhage, that may be increased by the mandatory peri- and post- procedural antiplatelet therapy in order to avoid stent thrombosis. 

Here we report a multicenter retrospective analysis on consecutive patients presenting tandem occlusion undergoing emergent carotid artery stenting (eCAS) with mechanical thrombectomy (MT). Our primary aim was to study the safe use of intravenous thrombolysis (IVT) and concomitant antiplatelet therapy in such cohort. Our second objective was to define predictors of intracranial bleeding.

The prospective databases of 17 European high-volume stroke centers were screened for consecutive patients with AIS secondary to tandem occlusion, who underwent eCAS with MT, between 2016 and 2023. Since our data were not randomized, we used two different matching methods in order to estimate the treatment effect of IVT, accounting for differences in baseline variables that included: age, NIHSS at baseline, ASPECT score, use of antiplatelet at baseline, use of anticoagulant at baseline, intraprocedural and postprocedural antiplatelet regimen. 

Among 621 collected patients, 301 patients received IVT. The results after matched analysis confirmed that IVT was not associated with a higher rate of intracranial hemorrhage, reporting higher rates of favorable clinical outcome. ATT for the chosen safety outcomes confirmed that the use of IVT in such patients is feasible and safe. The use of a high-intensity intraprocedural antiplatelet regimen with postprocedural GPI infusion resulted as a predictive factor for intracranial bleeding, conversely postprocedural dual antiplatelet therapy is associated with significant lower rates of intracerebral hemorrhage. 

In patients with tandem occlusion, the use of different antiplatelet regimens for e-CAS is feasible and safe after IVT. Moreover, patients who received IVT show higher rates of good long-term functional outcome.

Francesca Colò, MD (Policlinico Agostino Gemelli)
Dr. Colò has nothing to disclose.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Giovanni Frisullo, PhD (Univ Catt S Cuore Polic Gemelli) Dr. Frisullo has nothing to disclose.
Paolo Calabresi, MD (Clinica Neurologica) Dr. Calabresi has nothing to disclose.
No disclosure on file