Acute carotid stenting plus aspirin during thrombectomy of tandem occlusions: A matched case-control study

Area of Science:

• Neuroendovascular surgery
• Cerebrovascular disease management
• Acute ischemic stroke treatment

Background:

• Acute carotid artery stenting (CAS) for anterior circulation tandem occlusions necessitates antiplatelet therapy to prevent stent thrombosis.
• Limited randomized trial data exists on the safety of additional antiplatelet agents in these patients.
• Previous studies show inconsistent results regarding safety and efficacy.

Purpose of the Study:

• To compare the safety and functional outcomes of acute CAS with Aspirin during thrombectomy for tandem occlusions versus thrombectomy alone for isolated intracranial occlusions.
• To evaluate the incidence of symptomatic intracerebral hemorrhage, parenchymal hematoma, any intracerebral hemorrhage, and 90-day mortality.
• To assess early neurological improvement and functional outcomes at 90 days.

Main Methods:

• Retrospective review of two prospectively acquired mechanical thrombectomy databases (August 2017 - December 2021).
• Inclusion criteria: patients with carotid atherosclerotic tandem occlusions treated with acute CAS and intravenous Aspirin (250 mg) during thrombectomy, with additional antiplatelet agents post-procedure.
• Comparison group: matched cohort of patients with isolated intracranial occlusions treated with thrombectomy alone.

Main Results:

• 70 patients (4.5%) with tandem occlusions received CAS plus Aspirin; 1557 patients total were included.
• No significant differences were observed in symptomatic intracerebral hemorrhage (OR, 3.06; P=0.150), parenchymal hematoma type 2 (OR, 1.15; P=0.856), any intracerebral hemorrhage (OR, 1.84; P=0.182), or 90-day mortality (OR, 0.79; P=0.708).
• Rates of early neurological improvement and 90-day modified Rankin Scale score 0-2 were comparable between groups.

Conclusions:

• Acute CAS with Aspirin during thrombectomy for tandem occlusion stroke appears to be a safe treatment strategy.
• The safety profile is comparable to thrombectomy alone for isolated intracranial occlusions.
• Randomized controlled trials are recommended to validate these findings and establish definitive guidelines.