Osteraas Nicholas D, Crowley Richard W, Panos Nicholas, Dafer Rima M
Rush University Medical Center, 1725 W Harrison street Suite 1118, Chicago, IL 60605, United States.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105021. doi: 10.1016/j.jstrokecerebrovasdis.2020.105021. Epub 2020 Jun 17.
Early revascularization of the extracranial internal carotid artery in acute anterior circulation ischemic stroke (ACIS) is feasible and may improve clinical outcome. When a stent is deployed, antithrombotic agents should be administered peri-procedurally to ensure stent patency. Our institution implemented a protocol for the use of eptifibatide as a means of maintaining stent patency in the treatment of ACIS associated with cervical internal carotid artery occlusion.
Our internal database was queried for patients who received emergent endovascular therapy (ET) for ACIS with stent placement and eptifibatide administration between July 2016 and 2019.
Twenty nine patients met the study criteria. The etiology was large artery atherosclerosis in 26 cases. Two patients had a dissection (7%), and one had a carotid occlusion related to a recent carotid endarterectomy. Mean NIHSS was 14. Sixteen patients received IVrtPA. Extracranial-intracranial tandem occlusion (TO) was present in 21 of cases. All patients received an eptifibatide bolus followed by an infusion for approximately 24 hours post stent deployment. Head CT was obtained prior to initiation of oral dual antiplatelet therapy with aspirin and clopidogrel. Successful recanalization was achieved in all patients with no evidence of downstream embolization. Symptomatic intracerebral hemorrhage occurred in one patient. Stent occlusion occurred in two patients, only one of which was symptomatic. Favorable clinical outcome with mRS ≤ 2 at 3 months was achieved in seventeen patients.
The use of eptifibatide post procedure was associated with low risk of symptomatic intracranial hemorrhage, including in patients treated with rtPA.
急性前循环缺血性卒中（ACIS）患者颅外颈内动脉早期血管重建是可行的，且可能改善临床结局。在植入支架时，应在围手术期使用抗血栓药物以确保支架通畅。我们机构实施了一项使用依替巴肽的方案，作为维持与颈内动脉闭塞相关的ACIS治疗中支架通畅的一种手段。
查询我们的内部数据库，以获取2016年7月至2019年期间接受急诊血管内治疗（ET）治疗ACIS并植入支架及使用依替巴肽的患者。
29例患者符合研究标准。病因是大动脉粥样硬化26例。2例患者有夹层（7%），1例患者的颈动脉闭塞与近期颈动脉内膜切除术有关。美国国立卫生研究院卒中量表（NIHSS）平均为14分。16例患者接受了静脉注射重组组织型纤溶酶原激活剂（IVrtPA）。21例患者存在颅外-颅内串联闭塞（TO）。所有患者在支架植入后均接受依替巴肽推注，随后输注约24小时。在开始使用阿司匹林和氯吡格雷进行口服双联抗血小板治疗前进行头颅CT检查。所有患者均成功再通，无下游栓塞证据。1例患者发生有症状性脑出血。2例患者发生支架闭塞，其中仅1例有症状。17例患者在3个月时改良Rankin量表（mRS）≤2，获得良好临床结局。
术后使用依替巴肽与有症状性颅内出血的低风险相关，包括接受rtPA治疗的患者。
