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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

      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)
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