Impact of Antiplatelet Therapy During Endovascular Therapy for Tandem Occlusions

François Zhu (1, 2) , Mohammad Anadani (3, 4) , Julien Labreuche (5) , Alejandro Spiotta (4) , Francis Turjman (6) , Michel Piotin (7) , Henrik Steglich-Arnholm (8) , Markus Holtmannspötter (8) , Christian Taschner (9) , Sebastian Eiden (9) , Diogo Haussen (10) , Raul Nogueira (10) , Panagiotis Papanagiotou (11) , Maria Boutchakova (11) , Adnan Siddiqui (12) , Bertrand Lapergue (13) , Franziska Dorn (14) , Christophe Cognard (15) , Monika Killer-Oberpfalzer (16) , Salvatore Mangiafico (17) , Marc Ribo (18) , Marios Psychogios (19) , Marc-Antoine Labeyrie (20) , Mikael Mazighi (7) , Alessandra Biondi (21) , René Anxionnat (2, 1) , Serge Bracard (2, 1) , Sébastien Richard (22, 23, 24) , Benjamin Gory (2, 1) , Jonathan Andrew Grossberg , Adrien Guenego , Julien Darcourt , Isabelle Vukasinovic , Elisa Pomero , Jason Davies , Leonardo Renieri , Corentin Hecker , Maria Muchada Muchada , Arturo Consoli (13) , Georges Rodesch (13) , Emmanuel Houdart (20) , Johanna Lockau , Andreas Kastrup , Raphaël Blanc (25) , Hocine Redjem (7) , Daniel Behme , Hussain Shallwani , Maurer Christopher , Gioia Mione (26) , Lisa Humbertjean (27) , Jean-Christophe Lacour (22) , Nolwenn Riou-Comte , Anne-Laure Derelle (1) , Romain Tonnelet (28) , Liang Liao (27)

1 Département de neuroradiologie diagnostique et thérapeutique [CHRU Nancy]
2 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
3 Washington University School of Medicine in St. Louis
4 MUSC - Medical University of South Carolina [Charleston]
5 METRICS - Evaluation des technologies de santé et des pratiques médicales - ULR 2694
6 HCL - Hospices Civils de Lyon
7 CHU Rothschild [AP-HP]
8 Rigshospitalet [Copenhagen]
9 Uniklinik - Universitäts Klinikum Freiburg = University Medical Center Freiburg
10 Emory University School of Medicine
11 Klinikum Bremen-Mitte
12 SUNY Buffalo - University at Buffalo [SUNY]
13 Hôpital Foch [Suresnes]
14 University-Hospital Munich-Großhadern [München]
15 Pôle Cardiovasculaire et Métabolique [CHU Toulouse]
16 PMU - Paracelsus Medizinische Privatuniversität = Paracelsus Medical University
17 AOUC - Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy]
18 Vall d'Hebron University Hospital [Barcelona]
19 UMG - University Medical Center Göttingen
20 Service de Neuroradiologie [CHU Lariboisière]
21 Service de Neuroradiologie [CHRU Besançon]
22 Service de neurologie [CHRU Nancy]
23 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
24 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
25 Service de Neuroradiologie Interventionnelle et Fonctionnelle
26 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
27 UL - Université de Lorraine
28 Service d’Anatomie Pathologique [CHRU Nancy]

Background and Purpose- Antiplatelet agents could be used in the setting of endovascular therapy for tandem occlusions to reduce the risk of de novo intracranial embolic migration, reocclusion of the extracranial internal carotid artery lesion, or in-stent thrombosis in case of carotid stent placement but have to be balanced with the intracerebral hemorrhagic transformation risk. In this study, we aim to investigate the impact of acute antiplatelet therapy administration on outcomes during endovascular therapy for anterior circulation tandem occlusions. Methods- This is a retrospective analysis of a collaborative pooled analysis of 11 prospective databases from the multicenter observational TITAN registry (Thrombectomy in Tandem Lesions). Patients were divided into groups based on the number of antiplatelet administered during endovascular therapy. The primary outcome was favorable outcome, defined as a modified Rankin Scale score of 0 to 2 at 90 days. Results- This study included a total of 369 patients; 145 (39.3%) did not receive any antiplatelet agent and 224 (60.7%) received at least 1 antiplatelet agent during the procedure. Rate of favorable outcome was nonsignificantly higher in patients treated with antiplatelet therapy (58.3%) compared with those treated without antiplatelet (46.0%; adjusted odds ratio, 1.38 [95% CI, 0.78-2.43]; P=0.26). Rate of 90-day mortality was significantly lower in patients treated with antiplatelet therapy (11.2% versus 18.7%; adjusted odds ratio, 0.47 [95% CI, 0.22-0.98]; P=0.042), without increasing the risk of any intracerebral hemorrhage. Successful reperfusion (modified Thrombolysis in Cerebral Ischemia score 2b-3) rate was significantly better in the antiplatelet therapy group (83.9% versus 71.0%; adjusted odds ratio, 1.89 [95% CI, 1.01-3.64]; P=0.045). Conclusions- Administration of antiplatelet therapy during endovascular therapy for anterior circulation tandem occlusions was safe and was associated with a lower 90-day mortality. Optimal antiplatelet therapy remains to be assessed, especially when emergent carotid artery stenting is performed. Further randomized controlled trials are needed.

Domaines: Sciences de l'Homme et Société; Sciences du Vivant [q-bio]; Médecine humaine et pathologie; Cardiologie et système cardiovasculaire

François Zhu, Mohammad Anadani, Julien Labreuche, Alejandro Spiotta, Francis Turjman, et al.. Impact of Antiplatelet Therapy During Endovascular Therapy for Tandem Occlusions. Stroke, 2020, 51 (5), pp.1522-1529. ⟨10.1161/STROKEAHA.119.028231⟩. ⟨hal-02860909⟩