Impact of intraprocedural antiplatelet therapy on stent patency and safety after emergent intracranial stenting in acute ischaemic stroke: insights from the RESISTANT registry.
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Diana Francesco, Hassan Ameer E, Ortega-Gutierrez Santiago, Miller Samantha, Rodriguez-Calienes Aaron, Olive Gadea Marta, Kaesmacher Johannes, Mujanovic Adnan, Geyik Serdar, Senadim Songul, Piano Mariangela, Cervo Amedeo, Salcuni Andrea, Moreu Manuel, López-Frías Alfonso, Zapata Arriaza Elena, de Albóniga-Chindurza Asier, Bergui Mauro, Molinaro Stefano, Sousa João André, Sargento-Freitas João, Gomes Fábio, Alexandre Andrea, Pedicelli Alessandro, Machi Paolo, Hofmeister Jeremy, Scarcia Luca, Kalsoum Erwah, Amorim Jose, Meira Torcato, Renieri Leonardo, Capasso Francesco, Romano Daniele G, Barcena Eduardo, Seoane David, Abdalkader Mohamad, Klein Piers, Nguyen Thanh N, Perry Catarina, Fragata Isabel, Yavagal Dileep R, Charles Jude H, Rodríguez José, Vega Pedro, Özdemir Atilla Ö, Uysal Zehra, Smajda Stanislas, Al Salman Sadiq, Khalife Jane, Jovin Tudor, Biraschi Francesco, Ricchetti Francesca, Castro Pedro, Albuquerque Luis, Siddiqui Adnan H, Jaikumar Vinay, Navia Pedro, Ntoulias Nikolaos, Psychogios Marios, Velo Mariano, Zamarro Joaquín, de Paco Gonzalo, Ashouri Yazan, AlMajali Mohammad, Arenillas Juan F, Sierra Alicia, Romoli Michele, Marto João Pedro, Yaghi Shadi, Peschillo Simone, Ribo Marc, Tomasello Alejandro, Requena Manuel
Аннотация
PATIENTS AND METHODS: This is a subanalysis of the RESISTANT registry, which is a multicenter retrospective registry of patients with acute ischaemic stroke treated with intracranial EIS between 2016 and 2023. Patients receiving intraprocedural antithrombotics were included. Primary efficacy outcomes were stent patency (intraprocedural and within 24 hours) and 3-month mRS. Secondary outcome was successful reperfusion (modified thrombolysis in cerebral infarction ≥ 2b), and the safety outcome was sICH. Multivariable and propensity score-matched analyses were performed.
RESULTS: Among 827 patients, 4 APT strategies were identified: single APT (n = 102), oral dual antiplatelet therapy (dAPT) (Aspirin + Clopidogrel or Ticagrelor; n = 83), Cangrelor (n = 92) and GP IIb/IIIa inhibitors (GPi) (n = 550). Intravenous agents (Cangrelor/GPi) showed a trend towards lower risk of intraprocedural stent occlusion compared to oral dAPT (adjusted odds ratio [aOR] 0.30, [95% CI, 0.09-1.01], P = .053), though this did not reach statistical significance. GP IIb/IIIa inhibitors continued to demonstrate a protective trend at 24 hours (aOR 0.25, [95% CI, 0.06-0.99], P = .047), without a significant increase in sICH. Both intravenous agents were independently associated with higher odds of successful final reperfusion (odds ratio [OR] 4.35, [95% CI, 1.57-12.09], P = .001). No significant differences emerged between GPi and Cangrelor in matched analysis. No significant difference was observed on good functional outcome between APT strategies.
CONCLUSION: In the setting of EIS, intravenous APT agents (Cangrelor or GPi) were associated with improved stent patency and higher rates of successful reperfusion, without a significant increase in symptomatic haemorrhage.