Antiplatelet pretreatment and outcomes following mechanical thrombectomy for emergent large vessel occlusion strokes

Abhi Pandhi, Georgios Tsivgoulis, Rashi Krishnan, Muhammad F. Ishfaq, Savdeep Singh, Daniel Hoit, Adam Arthur, Christopher Nickele, Andrei Alexandrov, Lucas Elijovich, Nitin Goyal

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Few data are available regarding the safety and efficacy of antiplatelet (APT) pretreatment in acute ischemic stroke (AIS) patients with emergent large vessel occlusions (ELVO) treated with mechanical thrombectomy (MT). We sought to evaluate the association of APT pretreatment with safety and efficacy outcomes following MT for ELVO. Methods Consecutive ELVO patients treated with MT during a 4-year period in a tertiary stroke center were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), successful recanalization (SR; modified TICI score 2b/3), mortality, and functional independence (modified Rankin Scale scores of 0-2). Results The study population included 217 patients with ELVO (mean age 62±14 years, 50% men, median NIH Stroke Scale score 16). APT pretreatment was documented in 71 cases (33%). Patients with APT pretreatment had higher SR rates (77% vs 61%; P=0.013). The two groups did not differ in terms of sICH (6% vs 7%), 3-month mortality (25% vs 26%), and 3-month functional independence (50% vs 48%). Pretreatment with APT was independently associated with increased likelihood of SR (OR 2.18, 95% CI1.01 to 4.73; P=0.048) on multivariable logistic regression models adjusting for potential confounders. A significant interaction (P=0.014) of intravenous thrombolysis (IVT) pretreatment on the association of pre-hospital antiplatelet use with SR was detected. APT pretreatment was associated with SR (OR 2.74, 95% CI 1.15 to 6.54; P=0.024) in patients treated with combination therapy (IVT and MT) but not in those treated with direct MT (OR 1.78, 95% CI 0.63 to 5.03; P=0.276). Conclusion APT pretreatment does not increase the risk of sICH and may independently improve the odds of SR in patients with ELVO treated with MT. The former association appears to be modified by IVT.

Original languageEnglish (US)
Pages (from-to)828-833
Number of pages6
JournalJournal of neurointerventional surgery
Volume10
Issue number9
DOIs
StatePublished - Sep 1 2018

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Thrombectomy
Stroke
Intracranial Hemorrhages
Mechanical Thrombolysis
Logistic Models
Safety
Mortality
Population

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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Antiplatelet pretreatment and outcomes following mechanical thrombectomy for emergent large vessel occlusion strokes. / Pandhi, Abhi; Tsivgoulis, Georgios; Krishnan, Rashi; Ishfaq, Muhammad F.; Singh, Savdeep; Hoit, Daniel; Arthur, Adam; Nickele, Christopher; Alexandrov, Andrei; Elijovich, Lucas; Goyal, Nitin.

In: Journal of neurointerventional surgery, Vol. 10, No. 9, 01.09.2018, p. 828-833.

Research output: Contribution to journalArticle

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title = "Antiplatelet pretreatment and outcomes following mechanical thrombectomy for emergent large vessel occlusion strokes",
abstract = "Background Few data are available regarding the safety and efficacy of antiplatelet (APT) pretreatment in acute ischemic stroke (AIS) patients with emergent large vessel occlusions (ELVO) treated with mechanical thrombectomy (MT). We sought to evaluate the association of APT pretreatment with safety and efficacy outcomes following MT for ELVO. Methods Consecutive ELVO patients treated with MT during a 4-year period in a tertiary stroke center were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), successful recanalization (SR; modified TICI score 2b/3), mortality, and functional independence (modified Rankin Scale scores of 0-2). Results The study population included 217 patients with ELVO (mean age 62±14 years, 50{\%} men, median NIH Stroke Scale score 16). APT pretreatment was documented in 71 cases (33{\%}). Patients with APT pretreatment had higher SR rates (77{\%} vs 61{\%}; P=0.013). The two groups did not differ in terms of sICH (6{\%} vs 7{\%}), 3-month mortality (25{\%} vs 26{\%}), and 3-month functional independence (50{\%} vs 48{\%}). Pretreatment with APT was independently associated with increased likelihood of SR (OR 2.18, 95{\%} CI1.01 to 4.73; P=0.048) on multivariable logistic regression models adjusting for potential confounders. A significant interaction (P=0.014) of intravenous thrombolysis (IVT) pretreatment on the association of pre-hospital antiplatelet use with SR was detected. APT pretreatment was associated with SR (OR 2.74, 95{\%} CI 1.15 to 6.54; P=0.024) in patients treated with combination therapy (IVT and MT) but not in those treated with direct MT (OR 1.78, 95{\%} CI 0.63 to 5.03; P=0.276). Conclusion APT pretreatment does not increase the risk of sICH and may independently improve the odds of SR in patients with ELVO treated with MT. The former association appears to be modified by IVT.",
author = "Abhi Pandhi and Georgios Tsivgoulis and Rashi Krishnan and Ishfaq, {Muhammad F.} and Savdeep Singh and Daniel Hoit and Adam Arthur and Christopher Nickele and Andrei Alexandrov and Lucas Elijovich and Nitin Goyal",
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T1 - Antiplatelet pretreatment and outcomes following mechanical thrombectomy for emergent large vessel occlusion strokes

AU - Pandhi, Abhi

AU - Tsivgoulis, Georgios

AU - Krishnan, Rashi

AU - Ishfaq, Muhammad F.

AU - Singh, Savdeep

AU - Hoit, Daniel

AU - Arthur, Adam

AU - Nickele, Christopher

AU - Alexandrov, Andrei

AU - Elijovich, Lucas

AU - Goyal, Nitin

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background Few data are available regarding the safety and efficacy of antiplatelet (APT) pretreatment in acute ischemic stroke (AIS) patients with emergent large vessel occlusions (ELVO) treated with mechanical thrombectomy (MT). We sought to evaluate the association of APT pretreatment with safety and efficacy outcomes following MT for ELVO. Methods Consecutive ELVO patients treated with MT during a 4-year period in a tertiary stroke center were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), successful recanalization (SR; modified TICI score 2b/3), mortality, and functional independence (modified Rankin Scale scores of 0-2). Results The study population included 217 patients with ELVO (mean age 62±14 years, 50% men, median NIH Stroke Scale score 16). APT pretreatment was documented in 71 cases (33%). Patients with APT pretreatment had higher SR rates (77% vs 61%; P=0.013). The two groups did not differ in terms of sICH (6% vs 7%), 3-month mortality (25% vs 26%), and 3-month functional independence (50% vs 48%). Pretreatment with APT was independently associated with increased likelihood of SR (OR 2.18, 95% CI1.01 to 4.73; P=0.048) on multivariable logistic regression models adjusting for potential confounders. A significant interaction (P=0.014) of intravenous thrombolysis (IVT) pretreatment on the association of pre-hospital antiplatelet use with SR was detected. APT pretreatment was associated with SR (OR 2.74, 95% CI 1.15 to 6.54; P=0.024) in patients treated with combination therapy (IVT and MT) but not in those treated with direct MT (OR 1.78, 95% CI 0.63 to 5.03; P=0.276). Conclusion APT pretreatment does not increase the risk of sICH and may independently improve the odds of SR in patients with ELVO treated with MT. The former association appears to be modified by IVT.

AB - Background Few data are available regarding the safety and efficacy of antiplatelet (APT) pretreatment in acute ischemic stroke (AIS) patients with emergent large vessel occlusions (ELVO) treated with mechanical thrombectomy (MT). We sought to evaluate the association of APT pretreatment with safety and efficacy outcomes following MT for ELVO. Methods Consecutive ELVO patients treated with MT during a 4-year period in a tertiary stroke center were evaluated. The following outcomes were documented using standard definitions: symptomatic intracranial hemorrhage (sICH), successful recanalization (SR; modified TICI score 2b/3), mortality, and functional independence (modified Rankin Scale scores of 0-2). Results The study population included 217 patients with ELVO (mean age 62±14 years, 50% men, median NIH Stroke Scale score 16). APT pretreatment was documented in 71 cases (33%). Patients with APT pretreatment had higher SR rates (77% vs 61%; P=0.013). The two groups did not differ in terms of sICH (6% vs 7%), 3-month mortality (25% vs 26%), and 3-month functional independence (50% vs 48%). Pretreatment with APT was independently associated with increased likelihood of SR (OR 2.18, 95% CI1.01 to 4.73; P=0.048) on multivariable logistic regression models adjusting for potential confounders. A significant interaction (P=0.014) of intravenous thrombolysis (IVT) pretreatment on the association of pre-hospital antiplatelet use with SR was detected. APT pretreatment was associated with SR (OR 2.74, 95% CI 1.15 to 6.54; P=0.024) in patients treated with combination therapy (IVT and MT) but not in those treated with direct MT (OR 1.78, 95% CI 0.63 to 5.03; P=0.276). Conclusion APT pretreatment does not increase the risk of sICH and may independently improve the odds of SR in patients with ELVO treated with MT. The former association appears to be modified by IVT.

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DO - 10.1136/neurintsurg-2017-013532

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