Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis
Abstract Background Acute stroke treatment with intracranial thrombectomy and treatment of ipsilateral carotid artery stenosis/occlusion (“tandem lesion”, TL) in one session is considered safe. However, the risk of stent restenosis after TL treatment is high, and antiplatelet therapy (APT) preventin...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | BMC Neurology |
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| Online Access: | https://doi.org/10.1186/s12883-024-03597-0 |
| _version_ | 1797247176290598912 |
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| author | Ali Khanafer Hans Henkes Philipp Bücke Florian Hennersdorf Hansjörg Bäzner Michael Forsting Philipp von Gottberg |
| author_facet | Ali Khanafer Hans Henkes Philipp Bücke Florian Hennersdorf Hansjörg Bäzner Michael Forsting Philipp von Gottberg |
| author_sort | Ali Khanafer |
| collection | DOAJ |
| description | Abstract Background Acute stroke treatment with intracranial thrombectomy and treatment of ipsilateral carotid artery stenosis/occlusion (“tandem lesion”, TL) in one session is considered safe. However, the risk of stent restenosis after TL treatment is high, and antiplatelet therapy (APT) preventing restenosis must be well balanced to avoid intracranial hemorrhage. We investigated the safety and 90-day outcome of patients receiving TL treatment under triple-APT, focused on stent-patency and possible disadvantageous comorbidities. Methods Patients receiving TL treatment in the setting of acute stroke between 2013 and 2022 were analyzed regarding peri-/postprocedural safety and stent patency after 90 days. All patients received intravenous eptifibatide and acetylsalicylic acid and one of the three drugs prasugrel, clopidogrel, or ticagrelor. Duplex imaging was performed 24 h after treatment, at discharge and 90 days, and digital subtraction angiography was performed if restenosis was suspected. Results 176 patients were included. Periprocedural complications occurred in 2.3% of the patients at no periprocedural death, and in-hospital death in 13.6%. Discharge mRS score was maintained or improved at the 90-day follow-up in 86%, 4.54% had an in-stent restenosis requiring treatment at 90 days. No recorded comorbidity considered disadvantageous for stent patency showed statistical significance, the duration of the endovascular procedure had no significant effect on outcome. Conclusion In our data, TL treatment with triple APT resulted in a low restenosis rate, low rates of sICH and a comparably high number of patients with favorable outcome. Aggressive APT in the initial phase may therefore have the potential to prevent recurrent stroke better than restrained platelet inhibition. Comorbidities did not influence stent patency. |
| first_indexed | 2024-04-24T19:54:32Z |
| format | Article |
| id | doaj.art-0963334f82af4c82a82272ca99a1ae07 |
| institution | Directory Open Access Journal |
| issn | 1471-2377 |
| language | English |
| last_indexed | 2024-04-24T19:54:32Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj.art-0963334f82af4c82a82272ca99a1ae072024-03-24T12:24:26ZengBMCBMC Neurology1471-23772024-03-012411810.1186/s12883-024-03597-0Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysisAli Khanafer0Hans Henkes1Philipp Bücke2Florian Hennersdorf3Hansjörg Bäzner4Michael Forsting5Philipp von Gottberg6Neuroradiological Clinic, Neurozentrum, Klinikum StuttgartNeuroradiological Clinic, Neurozentrum, Klinikum StuttgartDepartment of Neurology, Inselspital, Bern University Hospital, University of BernDepartment of Diagnostic and Interventional Neuroradiology, University of TübingenNeurological Clinic, Neurozentrum, Klinikum StuttgartInstitute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital EssenNeuroradiological Clinic, Neurozentrum, Klinikum StuttgartAbstract Background Acute stroke treatment with intracranial thrombectomy and treatment of ipsilateral carotid artery stenosis/occlusion (“tandem lesion”, TL) in one session is considered safe. However, the risk of stent restenosis after TL treatment is high, and antiplatelet therapy (APT) preventing restenosis must be well balanced to avoid intracranial hemorrhage. We investigated the safety and 90-day outcome of patients receiving TL treatment under triple-APT, focused on stent-patency and possible disadvantageous comorbidities. Methods Patients receiving TL treatment in the setting of acute stroke between 2013 and 2022 were analyzed regarding peri-/postprocedural safety and stent patency after 90 days. All patients received intravenous eptifibatide and acetylsalicylic acid and one of the three drugs prasugrel, clopidogrel, or ticagrelor. Duplex imaging was performed 24 h after treatment, at discharge and 90 days, and digital subtraction angiography was performed if restenosis was suspected. Results 176 patients were included. Periprocedural complications occurred in 2.3% of the patients at no periprocedural death, and in-hospital death in 13.6%. Discharge mRS score was maintained or improved at the 90-day follow-up in 86%, 4.54% had an in-stent restenosis requiring treatment at 90 days. No recorded comorbidity considered disadvantageous for stent patency showed statistical significance, the duration of the endovascular procedure had no significant effect on outcome. Conclusion In our data, TL treatment with triple APT resulted in a low restenosis rate, low rates of sICH and a comparably high number of patients with favorable outcome. Aggressive APT in the initial phase may therefore have the potential to prevent recurrent stroke better than restrained platelet inhibition. Comorbidities did not influence stent patency.https://doi.org/10.1186/s12883-024-03597-0StrokeCarotid artery stentingEndovascular thrombectomyIn-Stent restenosisAnti-platelet therapy |
| spellingShingle | Ali Khanafer Hans Henkes Philipp Bücke Florian Hennersdorf Hansjörg Bäzner Michael Forsting Philipp von Gottberg Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis BMC Neurology Stroke Carotid artery stenting Endovascular thrombectomy In-Stent restenosis Anti-platelet therapy |
| title | Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis |
| title_full | Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis |
| title_fullStr | Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis |
| title_full_unstemmed | Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis |
| title_short | Triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion: a retrospective single-center analysis |
| title_sort | triple platelet inhibition in intracranial thrombectomy with additional acute cervical stent angioplasty due to tandem lesion a retrospective single center analysis |
| topic | Stroke Carotid artery stenting Endovascular thrombectomy In-Stent restenosis Anti-platelet therapy |
| url | https://doi.org/10.1186/s12883-024-03597-0 |
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