Research Article| Volume 438, 120278, July 15, 2022

Impact of prior antiplatelet therapy on outcomes of endovascular therapy for acute ischemic stroke with large vessel occlusion: Sub-analysis of the RESCUE-Japan Registry 2


      • 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.



      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).


      The risk of ICH after EVT was not different between patients with and without APT before EVT for acute LVO.



      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)
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        • Mehta A.
        • Fifi J.T.
        • Shoirah H.
        • Singh I.P.
        • Shigematsu T.
        • Kellner C.P.
        • et al.
        National trends in utilization and outcome of endovascular thrombectomy for acute ischemic stroke in elderly.
        J. Stroke Cerebrovasc. Dis. 2021; 30105505
        • Dalkara T.
        • Arsava E.M.
        Can restoring incomplete microcirculatory reperfusion improve stroke outcome after thrombolysis?.
        J. Cereb. Blood Flow Metab. 2012; 32: 2091-2099
        • Kinjo N.
        • Yoshimura S.
        • Uchida K.
        • Sakai N.
        • Yamagami H.
        • Morimoto T.
        Incidence and prognostic impact of intracranial hemorrhage after endovascular treatment for acute large vessel occlusion.
        Cerebrovasc. Dis. 2020; 49: 540-549
        • van de Graaf R.A.
        • Zinkstok S.M.
        • Chalos V.
        • Goldhoorn R.B.
        • Majoie C.B.
        • van Oostenbrugge R.J.
        • et al.
        Prior antiplatelet therapy in patients undergoing endovascular treatment for acute ischemic stroke: results from the mr clean registry.
        Int. J. Stroke. 2021; 16: 476-485
        • Yoshimura S.
        • Sakai N.
        • Uchida K.
        • Yamagami H.
        • Ezura M.
        • Okada Y.
        • et al.
        Endovascular therapy in ischemic stroke with acute large-vessel occlusion: recovery by endovascular salvage for cerebral ultra-acute embolism Japan registry 2.
        J. Am. Heart Assoc. 2018; 7
        • van Swieten J.C.
        • Koudstaal P.J.
        • Visser M.C.
        • Schouten H.J.
        • van Gijn J.
        Interobserver agreement for the assessment of handicap in stroke patients.
        Stroke. 1988; 19: 604-607
        • Lyden P.
        • Brott T.
        • Tilley B.
        • Welch K.M.
        • Mascha E.J.
        • Levine S.
        • et al.
        Improved reliability of the nih stroke scale using video training. Ninds tpa stroke study group.
        Stroke. 1994; 25: 2220-2226
        • Adams Jr., H.P.
        • Bendixen B.H.
        • Kappelle L.J.
        • Biller J.
        • Love B.B.
        • Gordon D.L.
        • et al.
        Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. Toast. Trial of org 10172 in acute stroke treatment.
        Stroke. 1993; 24: 35-41
        • Pexman J.H.
        • Barber P.A.
        • Hill M.D.
        • Sevick R.J.
        • Demchuk A.M.
        • Hudon M.E.
        • et al.
        Use of the Alberta stroke program early ct score (aspects) for assessing ct scans in patients with acute stroke.
        AJNR Am. J. Neuroradiol. 2001; 22: 1534-1542
        • Barber P.A.
        • Hill M.D.
        • Eliasziw M.
        • Demchuk A.M.
        • Pexman J.H.
        • Hudon M.E.
        • et al.
        Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging.
        J. Neurol. Neurosurg. Psychiatry. 2005; 76: 1528-1533
        • DeLaPaz R.L.
        • New P.F.
        • Buonanno F.S.
        • Kistler J.P.
        • Oot R.F.
        • Rosen B.R.
        • et al.
        Nmr imaging of intracranial hemorrhage.
        J. Comput. Assist. Tomogr. 1984; 8: 599-607
        • von Kummer R.
        • Broderick J.P.
        • Campbell B.C.
        • Demchuk A.
        • Goyal M.
        • Hill M.D.
        • et al.
        The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy.
        Stroke. 2015; 46: 2981-2986
        • Wahlgren N.
        • Ahmed N.
        • Dávalos A.
        • Ford G.A.
        • Grond M.
        • Hacke W.
        • et al.
        Thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in stroke-monitoring study (sits-most): an observational study.
        Lancet. 2007; 369: 275-282
        • Marks M.P.
        • Lansberg M.G.
        • Mlynash M.
        • Kemp S.
        • McTaggart R.
        • Zaharchuk G.
        • et al.
        Correlation of aol recanalization, timi reperfusion and tici reperfusion with infarct growth and clinical outcome.
        J. Neurointerv. Surg. 2014; 6: 724-728
        • Uchida K.
        • Yoshimura S.
        • Imamura H.
        • Ohara N.
        • Sakai N.
        • Tanaka K.
        • et al.
        Effect of statin administration after onset of acute ischemic stroke with large vessel occlusion: insights from rescue-Japan registry 2.
        J. Am. Heart Assoc. 2020; 9e017472
        • Couture M.
        • Finitsis S.
        • Marnat G.
        • Richard S.
        • Bourcier R.
        • Constant-Dits-Beaufils P.
        • et al.
        Impact of prior antiplatelet therapy on outcomes after endovascular therapy for acute stroke: endovascular treatment in ischemic stroke registry results.
        Stroke. 2021; 52: 3864-3872
        • Yoshimura S.
        • Uchida K.
        • Sakai N.
        • Imamura H.
        • Yamagami H.
        • Tanaka K.
        • et al.
        Safety of early administration of apixaban on clinical outcomes in patients with acute large vessel occlusion.
        Transl. Stroke Res. 2021; 12: 266-274
        • Merlino G.
        • Sponza M.
        • Gigli G.L.
        • Lorenzut S.
        • Vit A.
        • Gavrilovic V.
        • et al.
        Prior use of antiplatelet therapy and outcomes after endovascular therapy in acute ischemic stroke due to large vessel occlusion: a single-center experience.
        J. Clin. Med. 2018; 7
        • Pandhi A.
        • Tsivgoulis G.
        • Krishnan R.
        • Ishfaq M.F.
        • Singh S.
        • Hoit D.
        • et al.
        Antiplatelet pretreatment and outcomes following mechanical thrombectomy for emergent large vessel occlusion strokes.
        J. Neurointerv. Surg. 2018; 10: 828-833