Multimodal endovascular reperfusion therapies

Abstract

Pharmacologic and mechanical endovascular acute ischemic stroke therapy aims to recanalize occluded cerebral vessels to achieve improved clinical outcome. Several limitations to achieving this goal have been identified; one of the least discussed challenges in the literature is reocclusion. The intraprocedure and periprocedural roles of anticoagulation and antiplatelet agents in preventing reocclusion are unclear. In this review, the role of antiplatelet and anticoagulation agents as an adjunctive to acute ischemic stroke endovascular revascularization therapy is discussed.

Structural properties of fracture haematoma: current status and future clinical implications

“…This pathway depends on a complex interaction between three main components, coagulation factors (mostly proteolytic enzymes), activated platelets and blood cells (Einhorn and Gerstenfeld, ). Under normal physiological conditions, tissue factors (TFs) are released that bind plasma factor VII, thus initiating the extrinsic clotting cascade (Figure ) (Lazzaro and Zaidat, ). During the clotting process, activated platelets can alter haematoma structure by clot retraction (Feghhi and Sniadecki, ), whereas the release of polyphosphates increases the pore size and reduces the number of fibre branching points (Mutch et al ., ); thrombospondin, on the other hand, promotes the formation of thinner and denser fibres (Nehls and Herrmann, ).…”

Future trials of endovascular mechanical recanalisation therapy in acute ischemic stroke patients - A position paper endorsed by ESMINT and ESNR

“…The preprocedural and intraprocedural role of fibrinolytic, anticoagulation and antiplatelet agents in endovascular stroke treatment is unclear [54].…”

“…Heparin Heparin has been used inconsistently during studies of endovascular stroke treatment [54]. In the IMS [56] and PROACT [57] trials, 2,000 units of IV heparin were administered at the beginning of the procedure followed by 450 units per hour during the procedure.…”

“…Antiplatelet agents Periprocedural antiplatelet therapy is often applied after deployment of implants to reduce the risk of acute and delayed stent thrombosis. There is no consensus on safety, dosage or drug combination [54].…”

“…Other GP IIb/IIIa inhibitors Due to their shorter half-life, GP IIb/IIIa inhibitors such as tirofiban and epitifibatide are frequently used during or after endovascular stroke treatment [54,65,66]. The SaTIS trial, a randomised, placebocontrolled trial, demonstrated the safety of Tirofiban and demonstrated no significant increase in bleeding risk (Stroke Trials Registry.…”