Increased Rates of Hemorrhages after Endovascular Stroke Treatment with Emergency Carotid Artery Stenting and Dual Antiplatelet Therapy.
Aged
Aged, 80 and over
Carotid Stenosis
/ diagnostic imaging
Cerebral Hemorrhage
/ chemically induced
Dual Anti-Platelet Therapy
/ adverse effects
Emergencies
Endovascular Procedures
/ adverse effects
Female
Humans
Male
Middle Aged
Platelet Aggregation Inhibitors
/ adverse effects
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Stents
Stroke
/ diagnostic imaging
Thrombectomy
/ adverse effects
Thrombolytic Therapy
/ adverse effects
Time Factors
Tirofiban
/ adverse effects
Treatment Outcome
Acute ischemic stroke
Antiplatelet therapy
Carotid artery stenosis
Carotid artery stenting
Cerebral hemorrhage
Endovascular stroke therapy
Interventional neuroradiology
Intracerebral hemorrhage
Intravenous thrombolysis
Treatment of acute stroke
Journal
Cerebrovascular diseases (Basel, Switzerland)
ISSN: 1421-9786
Titre abrégé: Cerebrovasc Dis
Pays: Switzerland
ID NLM: 9100851
Informations de publication
Date de publication:
2021
2021
Historique:
received:
20
07
2020
accepted:
09
10
2020
pubmed:
21
1
2021
medline:
10
8
2021
entrez:
20
1
2021
Statut:
ppublish
Résumé
While endovascular stroke treatment (EST) of large vessel occlusions in acute ischemic stroke (AIS) is proven to be safe and effective, there are subgroups of patients with increased rates of hemorrhages. Our goal was to identify risk factors for intracerebral hemorrhage and to assess whether acute carotid artery stenting (CAS) was associated with increased bleeding rates. We performed a retrospective analysis of our monocentric prospective stroke registry in the period from May 2010 to May 2018 and compared AIS patients receiving EST with (n = 73) versus without acute CAS (n = 548). Patients with intracranial stents, intra-arterial thrombolysis, or dissection of the carotid artery were excluded. Parenchymal hemorrhage rates (PH2 according to the ECASS classification) and symptomatic hemorrhage (sICH) rates were increased in EST patients receiving CAS with odds being 6.3 (PH2) and 6.5 (sICH) times higher (PH2 17.8 vs. 3.3%, p < 0.001 and sICH: 16.4 vs. 2.9%, p < 0.001). Additional systemic thrombolysis with rtPA (IVRTPA) was no risk factor for cerebral hemorrhage (p = 0.213). AIS patients receiving EST with acute CAS and consecutive tirofiban or dual antiplatelet therapy suffered from an increased risk of relevant secondary intracranial bleeding. After adjusting for confounders, tirofiban and dual antiplatelet therapy were associated with higher bleeding rates.
Sections du résumé
BACKGROUND
While endovascular stroke treatment (EST) of large vessel occlusions in acute ischemic stroke (AIS) is proven to be safe and effective, there are subgroups of patients with increased rates of hemorrhages. Our goal was to identify risk factors for intracerebral hemorrhage and to assess whether acute carotid artery stenting (CAS) was associated with increased bleeding rates.
METHODS
We performed a retrospective analysis of our monocentric prospective stroke registry in the period from May 2010 to May 2018 and compared AIS patients receiving EST with (n = 73) versus without acute CAS (n = 548). Patients with intracranial stents, intra-arterial thrombolysis, or dissection of the carotid artery were excluded.
RESULTS
Parenchymal hemorrhage rates (PH2 according to the ECASS classification) and symptomatic hemorrhage (sICH) rates were increased in EST patients receiving CAS with odds being 6.3 (PH2) and 6.5 (sICH) times higher (PH2 17.8 vs. 3.3%, p < 0.001 and sICH: 16.4 vs. 2.9%, p < 0.001). Additional systemic thrombolysis with rtPA (IVRTPA) was no risk factor for cerebral hemorrhage (p = 0.213).
CONCLUSION
AIS patients receiving EST with acute CAS and consecutive tirofiban or dual antiplatelet therapy suffered from an increased risk of relevant secondary intracranial bleeding. After adjusting for confounders, tirofiban and dual antiplatelet therapy were associated with higher bleeding rates.
Identifiants
pubmed: 33472192
pii: 000512204
doi: 10.1159/000512204
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Tirofiban
GGX234SI5H
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
162-170Informations de copyright
© 2021 S. Karger AG, Basel.