Antiplatelet Therapy for Carotid Artery Stenting

Enomoto, Yukiko; Yoshimura, Shinichi

doi:10.1159/000351686

Cited by 24 publications

(18 citation statements)

References 141 publications

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“…In patients with acute occlusions or relevant stenosis of large extracranial vessels acute stenting is sometimes necessary [8, 9]. Administration of antiplatelets is required to prevent reocclusion of stents [10, 11]. Furthermore, EVT can cause endothelial damage resulting in vessel stenosis, dissections and reocclusions [12, 13].…”

Section: Introductionmentioning

confidence: 99%

Does Antiplatelet Therapy during Bridging Thrombolysis Increase Rates of Intracerebral Hemorrhage in Stroke Patients?

et al. 2017

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BackgroundSymptomatic intracerebral hemorrhage (sICH) after bridging thrombolysis for acute ischemic stroke is a devastating complication. We aimed to assess whether the additional administration of aspirin during endovascular intervention increases bleeding rates.MethodsWe retrospectively compared bleeding complications and outcome in stroke patients who received bridging thrombolysis with (tPA+ASA) and without (tPA-ASA) aspirin during endovascular intervention between November 2008 and March 2014. Furthermore, we analyzed bleeding complications and outcome in antiplatelet naïve patients with those with prior or acute antiplatelet therapy.ResultsBaseline characteristics, previous medication, and dosage of rtPA did not differ between 50 tPA+ASA (39 aspirin naïve, 11 preloaded) and 181 tPA-ASA patients (p>0.05). tPA+ASA patients had more often internal carotid artery (ICA) occlusion (p<0.001), large artery disease (p<0.001) and received more often acute stenting of the ICA (p<0.001). 10/180 (5.6%) tPA-ASA patients and 3/49 (6.1%) tPA+ASA patients suffered a sICH (p = 1.0). Rates of asymptomatic intracerebral hemorrhage, systemic bleeding complications and outcome did not differ between both groups (p>0.1). There were no differences in bleeding complications and mortality among 112 bridging patients with antiplatelet therapy (62 preloaded, 39 acute administration, 11 both) and 117 antiplatelet naïve patients. In a logistic regression analysis, aspirin administration during endovascular procedure was not a predictor of sICH.ConclusionAntiplatelet therapy before or during bridging thrombolysis in patients with acute ischemic stroke did not increase the risk of bleeding complications and had no impact on outcome. This finding has to be confirmed in larger studies.

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Section: Introductionmentioning

confidence: 99%

Does Antiplatelet Therapy during Bridging Thrombolysis Increase Rates of Intracerebral Hemorrhage in Stroke Patients?

et al. 2017

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“…Antiplatelets might prevent thrombus formation and vessel reocclusion in damaged vessel. Furthermore, administration of antiplatelets is required to prevent reocclusion of stents [19,20]. However, previous studies showed an increase in bleeding complications in bridging patients who receive additional antiplatelet therapy during endovascular intervention: The ARTIS trial was stopped early because of an increased rate of sICH in the patient group in which infusion of 300 mg aspirin was started within 90 minutes of intravenous thrombolysis with alteplase, with no improvement in outcome.…”

Section: Discussionmentioning

confidence: 99%

Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches

Cirillo

Romano

Vornetti

et al. 2021

Preprint

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Background Occlusions of internal carotid artery (ICA), whether isolated or in tandem lesions (TL) have a poor response to treatment with intravenous thrombolysis. Previous studies have demonstrated the superiority of mechanical thrombectomy in the treatment of acute ischemic stroke (AIS) following large vessel occlusion, compared to standard intravenous fibrinolysis. The aim of our study was to describe endovascular treatment (EVT) in AIS due to ICA occlusion, whether isolated or in TL. Methods we assessed the association between 90-day outcome and clinical, demographic, imaging and procedure data in 51 consecutive patients with acute isolated ICA or TL occlusion who underwent endovascular treatment (EVT). We evaluated baseline NIHSS and mRS, ASPECTS, type of occlusion, stent placement, use of stent retrievers and/or thromboaspiration, duration of the procedure, mTICI, procedural therapy and complications. Results A favorable 90-day outcome (mRS 0–2) was achieved in 34 patients (67%) and was significantly associated with the use of dual antiplatelet therapy after the procedure (p = 0.008), shorter procedure duration (p = 0.031), TICI 2b-3 (p < 0.001) and lack of post-procedural hemorrhagic transformation (p = 0.001). Four patients did not survive, resulting in a mortality rate of 8% Conclusions EVT in the treatment of AIS due to ICA occlusion is safe and effective; mortality rates are in agreement with the current literature. The use of the stent is safe and promotes good angiographic results, as well as therapy with a GpIIb / IIIa inhibitor immediately after stent release which is also associated with better 3-month outcome and good revascularization.

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“… 10 11 It is recommended that patients who undergo procedures in the carotid artery receive DAPT (currently aspirin and clopidogrel) throughout the periprocedural period to decrease the risk of stent thrombosis/embolization; however, there is no evidencebased consensus as to how long DAPT should be continued or what kinds of antiplatelet drugs should be given. 39 Data regarding antiplatelet management in patients treated with stent placement in the intracranial cerebral artery are even more limited. Although our dataset included patients from the general population who underwent stent placement or angioplasty in a peripheral artery or intracranial or extracranial cerebral arteries, it was not possible to perform subgroup analysis due to the small number of patients who received stent placement or angioplasty in these vessels.…”

Section: Discussionmentioning

confidence: 99%

Association of Mortality with Antiplatelet Treatment in Patients with Stent Placement or Angioplasty: A Population-Based Nested Case-Control Study

et al. 2021

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Antiplatelet Therapy for Carotid Artery Stenting

Cited by 24 publications

References 141 publications

Does Antiplatelet Therapy during Bridging Thrombolysis Increase Rates of Intracerebral Hemorrhage in Stroke Patients?

Does Antiplatelet Therapy during Bridging Thrombolysis Increase Rates of Intracerebral Hemorrhage in Stroke Patients?

Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches

Association of Mortality with Antiplatelet Treatment in Patients with Stent Placement or Angioplasty: A Population-Based Nested Case-Control Study

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