Antithrombotic regimen in emergent carotid stenting for acute ischemic stroke due to tandem occlusion: a meta-analysis of aggregate data.
stent
stroke
thrombectomy
thrombolysis
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
25 Apr 2023
25 Apr 2023
Historique:
received:
14
02
2023
accepted:
14
04
2023
medline:
15
5
2023
pubmed:
15
5
2023
entrez:
15
5
2023
Statut:
aheadofprint
Résumé
The periprocedural antithrombotic regimen might affect the risk-benefit profile of emergent carotid artery stenting (eCAS) in patients with acute ischemic stroke (AIS) due to tandem lesions, especially after intravenous thrombolysis. We conducted a systematic review and meta-analysis to evaluate the safety and efficacy of antithrombotics following eCAS. We followed PRISMA guidelines and searched MEDLINE, Embase, and Scopus from January 1, 2004 to November 30, 2022 for studies evaluating eCAS in tandem occlusion. The primary endpoint was 90-day good functional outcome. Secondary outcomes were symptomatic intracerebral hemorrhage, in-stent thrombosis, delayed stent thrombosis, and successful recanalization. Meta-analysis of proportions and meta-analysis of odds ratios were implemented. 34 studies with 1658 patients were included. We found that the use of no antiplatelets (noAPT), single antiplatelet (SAPT), dual antiplatelets (DAPT), or glycoprotein IIb/IIIa inhibitors (GPI) yielded similar rates of good functional outcomes, with a marginal benefit of GPI over SAPT (OR 1.88, 95% CI 1.05 to 3.35, P In AIS due to tandem occlusion, the periprocedural antithrombotic regimen of eCAS seems to have a marginal effect on good functional outcome. Overall, high intensity antithrombotic therapy may provide a marginal benefit on good functional outcome and carotid stent patency without a significant increase in risk of sICH.
Sections du résumé
BACKGROUND
BACKGROUND
The periprocedural antithrombotic regimen might affect the risk-benefit profile of emergent carotid artery stenting (eCAS) in patients with acute ischemic stroke (AIS) due to tandem lesions, especially after intravenous thrombolysis. We conducted a systematic review and meta-analysis to evaluate the safety and efficacy of antithrombotics following eCAS.
METHODS
METHODS
We followed PRISMA guidelines and searched MEDLINE, Embase, and Scopus from January 1, 2004 to November 30, 2022 for studies evaluating eCAS in tandem occlusion. The primary endpoint was 90-day good functional outcome. Secondary outcomes were symptomatic intracerebral hemorrhage, in-stent thrombosis, delayed stent thrombosis, and successful recanalization. Meta-analysis of proportions and meta-analysis of odds ratios were implemented.
RESULTS
RESULTS
34 studies with 1658 patients were included. We found that the use of no antiplatelets (noAPT), single antiplatelet (SAPT), dual antiplatelets (DAPT), or glycoprotein IIb/IIIa inhibitors (GPI) yielded similar rates of good functional outcomes, with a marginal benefit of GPI over SAPT (OR 1.88, 95% CI 1.05 to 3.35, P
CONCLUSIONS
CONCLUSIONS
In AIS due to tandem occlusion, the periprocedural antithrombotic regimen of eCAS seems to have a marginal effect on good functional outcome. Overall, high intensity antithrombotic therapy may provide a marginal benefit on good functional outcome and carotid stent patency without a significant increase in risk of sICH.
Identifiants
pubmed: 37185107
pii: jnis-2023-020204
doi: 10.1136/jnis-2023-020204
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Maximilian Thormann
(M)
Liu Yang
(L)
Ansgar Berlis
(A)
Rémy Beaujeux
(R)
Dong-Hun Kang
(DH)
Guillaume Saliou
(G)
Daniele G Romano
(DG)
Gianfranco Vornetti
(G)
Roberto Floris
(R)
Benjamin Gory
(B)
Manuel Requena
(M)
Matteo Zanoni
(M)
Lucio D'Anna
(L)
Umberto Pensato
(U)
Keisuke Imai
(K)
Tudor G Jovin
(TG)
Rainer Dabitz
(R)
Anastasios Mpotsaris
(A)
Serdar Tütüncü
(S)
Stephanie Lescher
(S)
José E Cohen
(JE)
Hannah Lockau
(H)
Alejandro M Spiotta
(AM)
Jae Young Choi
(JY)
Sibylle Stampfl
(S)
Donald V Heck
(DV)
Woong Yoon
(W)
Daniel Giansante Abud
(DG)
Seungnam Son
(S)
Mikayel Grigoryan
(M)
Robert Fahed
(R)
Leonardo Rangel-Castilla
(L)
Fawaz Al-Mufti
(F)
Omer Faruk Eker
(OF)
Marta Wallocha
(M)
Tomas Klail
(T)
Doo Hyuk Kwon
(DH)
Shunsuke Yamashita
(S)
Informations de copyright
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.