Sornalingam Abira, Wegener Susanne, Stattmann Miranda, Baumann Jil, Thurner Patrick, Madjidyar Jawid, Husain Hakim Shakir, Krepuska Miklos, Globas Christoph, Luft Andreas R, Kulcsar Zsolt, Schubert Tilman
Department of Neuroradiology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, 8091, Switzerland.
Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
CVIR Endovasc. 2025 May 22;8(1):47. doi: 10.1186/s42155-025-00564-9.
Endovascular therapy (EVT) for large intracranial vessel occlusion or symptomatic hypoperfusion due to cervical artery dissection (CeAD) became the standard therapy in recent years. Stenting is frequently required to secure the dissection with subsequent need for GP IIb/IIIa inhibitors. However, a potential concern of antithrombotic therapy in acute stroke is the increased risk of intracerebral hemorrhage. The aim of the study was to assess the impact of the administration of a GP IIb/IIIa inhibitor imaging during endovascular treatment for acute ischemic stroke caused by CeAD on 90-day clinical outcome and intracranial hemorrhage.
This single-center retrospective cohort study enrolled CeAD patients with internal carotid artery (ICA) dissections treated with EVT from January 2015 to August 2022. We analysed the impact of different variables including postinterventional hemorrhage, revascularization success and the use of GP IIb/IIIa Inhibitors (eptifibatide) on 90-day favorable clinical outcome (mRS 0-2). NIHSS Scores were evaluated at different time points in relation to the 90-day clinical outcomes.
Forty-nine patients were included in the study. Thrombectomy was performed in all patients. In 33 patients, stenting was performed in addition to thrombectomy. 20 patients (40.8%) received eptifibatide periinterventionally. 31 out of 49 patients (63.3%) had a favorable 90-day clinical outcome (mRS 0-2). Five patients showed radiologically significant hemorrhage. The rate of successful reperfusion (TICI 2b-3) in the favorable 90-day outcome group was significantly higher than in the unfavorable 90-day outcome group.
In this study, the use of a GP IIb/IIIa inhibitor use during EVT for stroke caused by CeAD did not affect 90-day clinical outcome nor the incidence of intracranial hemorrhage. Successful reperfusion significantly correlated with favorable clinical outcome.
近年来，血管内治疗（EVT）已成为治疗大型颅内血管闭塞或因颈动脉夹层（CeAD）导致的症状性脑灌注不足的标准疗法。通常需要进行支架置入以固定夹层，随后需要使用糖蛋白IIb/IIIa抑制剂。然而，急性卒中抗栓治疗的一个潜在问题是脑出血风险增加。本研究的目的是评估在CeAD所致急性缺血性卒中的血管内治疗期间给予糖蛋白IIb/IIIa抑制剂成像对90天临床结局和颅内出血的影响。
这项单中心回顾性队列研究纳入了2015年1月至2022年8月接受EVT治疗的颈内动脉（ICA）夹层的CeAD患者。我们分析了不同变量的影响，包括介入后出血、血管再通成功情况以及糖蛋白IIb/IIIa抑制剂（依替巴肽）的使用对90天良好临床结局（改良Rankin量表评分0 - 2分）的影响。在与90天临床结局相关的不同时间点评估美国国立卫生研究院卒中量表（NIHSS）评分。
49例患者纳入研究。所有患者均接受了血栓切除术。33例患者除血栓切除外还进行了支架置入。20例患者（40.8%）在介入治疗期间接受了依替巴肽治疗。49例患者中有31例（63.3%）获得了良好的90天临床结局（改良Rankin量表评分0 - 2分）。5例患者出现影像学上显著的出血。90天良好结局组的成功再灌注率（脑梗死溶栓分级2b - 3级）显著高于90天不良结局组。
在本研究中，CeAD所致卒中的血管内治疗期间使用糖蛋白IIb/IIIa抑制剂对90天临床结局和颅内出血发生率均无影响。成功再灌注与良好的临床结局显著相关。
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