Yoshimoto Takeshi, Yamagami Hiroshi, Sakai Nobuyuki, Uchida Kazutaka, Shirakawa Manabu, Beppu Mikiya, Toyoda Kazunori, Matsumaru Yuji, Matsumoto Yasushi, Todo Kenichi, Hayakawa Mikito, Shindo Seigo, Morimoto Masafumi, Takeuchi Masataka, Imamura Hirotoshi, Ikeda Hiroyuki, Tanaka Kanta, Ishihara Hideyuki, Kakita Hiroto, Sano Takanori, Araki Hayato, Nomura Tatsufumi, Sakakibara Fumihiro, Yoshimura Shinichi
Department of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan.
Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
Front Neurol. 2024 Nov 21;15:1475882. doi: 10.3389/fneur.2024.1475882. eCollection 2024.
We aimed to clarify the association between intraoperative P2Y inhibitor administration during EVT and clinical outcomes in patients with anterior circulation TO stroke.
Among consecutive patients with acute ischemic stroke (AIS) enrolled in the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolic and Atherothrombotic Stroke with Large Vessel Occlusion Registry from 2016 to 2019, those with anterior circulation TOs who underwent EVT were analyzed. These patients were categorized into the following groups: those who received P2Y inhibitors during the perioperative period and those who did not receive P2Y inhibitors. The outcomes included good functional outcomes, as indicated by a modified Rankin Scale score of 0-2 at 90 days, and the incidence of symptomatic intracranial hemorrhage (SICH) was compared between the two groups. Multivariate logistic regression models were used to assess the association of outcomes with perioperative P2Y inhibitor administration. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the group that did not receive P2Y inhibitors as the reference. The perioperative period included the period in which antithrombotic therapy was administered immediately before EVT and during the operative period.
We enrolled 242 patients with AIS with anterior circulation TOs (42 females [17.4%]; median age, 76 [interquartile range, 69-81] years). Patients who received P2Y inhibitors during the perioperative period ( = 131) showed a higher frequency of carotid artery stenting than those who did not receive perioperative P2Y inhibitors ( = 111; 86.3% vs. 42.3%, < 0.01). Furthermore, patients who received perioperative P2Y inhibitors during the perioperative period had a higher incidence of good functional outcomes than those who did not receive perioperative P2Y inhibitors (42.0% vs. 32.4%; adjusted OR: 6.65, 95% CI: 1.88-23.53), with no significant differences between the groups in the incidence of SICH (5.3% vs. 8.1%; OR: 0.44; 95% CI: 0.09-2.09).
Perioperative administration of P2Y inhibitors may be associated with a higher frequency of good functional outcomes in patients undergoing EVT for AIS with anterior circulation TOs. However, since several confounding factors are involved in this sub-analysis of EVT for anterior circulation TOs, further studies are warranted.
我们旨在阐明血管内治疗（EVT）期间术中给予P2Y抑制剂与前循环大血管闭塞性卒中患者临床结局之间的关联。
在2016年至2019年纳入超急性脑栓塞和动脉粥样硬化血栓形成性卒中伴大血管闭塞登记研究中接受血管内挽救性恢复治疗的急性缺血性卒中（AIS）连续患者中，分析接受EVT治疗的前循环大血管闭塞患者。这些患者被分为以下两组：围手术期接受P2Y抑制剂的患者和未接受P2Y抑制剂的患者。结局包括功能良好的结局，以90天时改良Rankin量表评分为0 - 2表示，比较两组有症状颅内出血（SICH）的发生率。使用多变量逻辑回归模型评估结局与围手术期给予P2Y抑制剂之间的关联。以未接受P2Y抑制剂的组作为对照，计算95%置信区间（CI）的比值比（OR）。围手术期包括在EVT前立即给予抗栓治疗的时期和手术期间。
我们纳入了242例前循环大血管闭塞性AIS患者（42例女性[17.4%]；中位年龄76岁[四分位间距，69 - 81岁]）。围手术期接受P2Y抑制剂的患者（n = 131）与未接受围手术期P2Y抑制剂的患者（n = 111）相比，颈动脉支架置入频率更高（86.3%对42.3%，P < 0.01）。此外，围手术期接受P2Y抑制剂的患者功能良好结局的发生率高于未接受围手术期P2Y抑制剂的患者（42.0%对32.4%；调整后OR：6.65，95% CI：1.88 - 23.53），两组间SICH发生率无显著差异（5.3%对8.1%；OR：0.44；95% CI：0.09 - 2.09）。
对于前循环大血管闭塞性AIS接受EVT治疗的患者，围手术期给予P2Y抑制剂可能与更高频率的功能良好结局相关。然而，由于在前循环大血管闭塞性EVT的该亚组分析中涉及多个混杂因素，有必要进一步研究。
