From the Interventional Neuroradiology Department (R.P., A.H., D.M., D.N., M.M., R.B.), Strasbourg University Hospitals, Strasbourg, France
Institut de Chirurgie Minime Invasive Guidée par l'Image (R.P., R.B.), Strasbourg, France.
AJNR Am J Neuroradiol. 2021 May;42(5):921-925. doi: 10.3174/ajnr.A6993. Epub 2021 Feb 18.
Postprocedural dual-antiplatelet therapy is frequently withheld after emergent carotid stent placement during stroke thrombectomy. We aimed to assess whether antiplatelet regimen variations increase the risk of stent thrombosis beyond postprocedural day 1.
Retrospective review was undertaken of all consecutive thrombectomies for acute stroke with tandem lesions in the anterior circulation performed in a single comprehensive stroke center between January 9, 2011 and March 30, 2020. Patients were included if carotid stent patency was confirmed at day 1 postprocedure. The group of patients with continuous dual-antiplatelet therapy from day 1 was compared with the group of patients with absent/discontinued dual-antiplatelet therapy.
Of a total of 109 tandem lesion thrombectomies, 96 patients had patent carotid stents at the end of the procedure. The early postprocedural stent thrombosis rate during the first 24 hours was 14/96 (14.5%). Of 82 patients with patent stents at day 1, in 28 (34.1%), dual-antiplatelet therapy was either not initiated at day 1 or was discontinued thereafter. After exclusion of cases without further controls of stent patency, there was no significant difference in the rate of subacute/late stent thrombosis between the 2 groups: 1/50 (2%) in patients with continuous dual-antiplatelet therapy versus 0/22 (0%) in patients with absent/discontinued dual-antiplatelet therapy ( = 1.000). In total, we observed 88 patient days without any antiplatelet treatment and 471 patient days with single antiplatelet treatment.
Discontinuation of dual-antiplatelet therapy was not associated with an increased risk of stent thrombosis beyond postprocedural day 1. Further studies are warranted to better assess the additional benefit and optimal duration of dual-antiplatelet therapy after tandem lesion stroke thrombectomy.
在急性缺血性脑卒中血管内取栓术中，紧急颈动脉支架置入术后常停止双联抗血小板治疗。我们旨在评估抗血小板方案的改变是否会增加术后第 1 天以外支架血栓形成的风险。
回顾性分析了 2011 年 1 月 9 日至 2020 年 3 月 30 日期间，在一家综合性卒中中心连续进行的所有前循环串联病变急性卒中血管内取栓术患者。如果术后第 1 天证实颈动脉支架通畅，则纳入患者。比较从第 1 天开始持续双联抗血小板治疗的患者与无双联抗血小板治疗或双联抗血小板治疗中断的患者。
在总共 109 例串联病变取栓术中，96 例患者在手术结束时颈动脉支架通畅。术后 24 小时内早期支架血栓形成率为 14/96（14.5%）。在第 1 天支架通畅的 82 例患者中，28 例（34.1%）在第 1 天未开始双联抗血小板治疗或此后中断双联抗血小板治疗。排除无进一步支架通畅控制的病例后，两组间亚急性/晚期支架血栓形成率无显著差异：持续双联抗血小板治疗组 1/50（2%）与无双联抗血小板治疗或双联抗血小板治疗中断组 0/22（0%）（=1.000）。总共观察到 88 天无任何抗血小板治疗和 471 天单药抗血小板治疗。
术后第 1 天停止双联抗血小板治疗与支架血栓形成风险增加无关。需要进一步研究以更好地评估双联抗血小板治疗在串联病变卒中取栓术后的额外获益和最佳持续时间。
