Highlights
- •Hemorrhagic complications are concern in patients with LVO underwent EVT.
- •Few studies have evaluated the risks and benefits of APT before EVT for LVO.
- •Preoperative APT dose not increase any ICH nor symptomatic ICH.
- •Pretreatment with APT should not affect the decision of EVT for acute LVO patients.
Abstract
Background
The impact of prior antiplatelet therapy (APT) on clinical outcomes of endovascular
therapy (EVT) for large vessel occlusion (LVO) on clinical outcomes is uncertain.
We explored the associations between prior APT and in-hospital and 90-day outcomes
in a real-world setting.
Methods and results
The RESCUE-Japan Registry 2 is a physician-initiated registry of 2408 consecutive
patients with acute LVO admitted to hospital within 24 h of stroke onset. We compared
1281 patients who received EVT with and without APT before stroke onset (APT group
and No-APT group) in terms of intracranial hemorrhage (ICH) within 72 h after the
onset, successful recanalization after EVT, and the modified Rankin Scale (mRS) score
0–2 at 90 days were also evaluated. Among the 254 patients (19.8%) in the APT group,
68 (27%) patients presented any ICH and 265 (26%) patients in the No-APT group (adjusted
odds ratio [OR], 1.04; 95% confidence interval [CI], 0.71–1.53). The incidence of
symptomatic ICH and successful recanalization were also similar between the APT and
No-APT groups. The adjusted ORs of the APT group for mRS of 0–2 and death were 0.93
(95% CI, 0.62–1.41) and 0.59 (95% CI, 0.3–1.19), respectively. In patients with an
onset to door time ≥ 180 min, any ICH tended to be more prevalent in the APT group
than in their counterparts (P for interaction = 0.008).
Conclusions
The risk of ICH after EVT was not different between patients with and without APT
before EVT for acute LVO.
Keywords
Abbreviations:
EVT (endovascular therapy), LVO (large vessel occlusion), APT (antiplatelet therapy), ICH (intracranial hemorrhage), RESCUE-Japan Registry 2 (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism-Japan Registry 2), rt-PA (recombinant tissue plasminogen activator), mRS (modified Rankin Scale), NIHSS (National Institute of Health Stroke Scale), ASPECTS (Alberta Stroke Program Early CT Score), DWI (diffusion-weighted image), HI (hemorrhagic infarction), PH (parenchymal hematoma), SAH (subarachnoid hemorrhage), PHr (remote parenchymal hematoma), sICH (symptomatic ICH), TICI (thrombolysis in cerebral infarction)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 10, 2022
Accepted:
May 6,
2022
Received in revised form:
March 30,
2022
Received:
December 14,
2021
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
