[en] Immediate reocclusion after mechanical thrombectomy (MT) for acute ischemic stroke (AIS) is a rare but devastating condition associated with poor functional outcome. The aim of this study was to gain insights into the mechanisms underlying immediate reocclusion, and to evaluate the efficacy and safety of the glycoprotein IIb/IIIa antagonist abciximab, for its treatment. Clinical data were collected from April 2015 to April 2019 in a monocentric prospective registry of AIS patients treated by MT. All patients with immediate reocclusion were retrospectively selected and subdivided into 2 groups according to abciximab treatment status. In vitro, the separate and combined effects of abciximab and alteplase on clot formation in whole blood under flow conditions were further investigated in microfluidic chambers. From 929 MT-treated patients, 21 had post-MT immediate reocclusion. Abciximab treatment in reocclusion patients (n = 10) led to higher rate of final recanalization (p < .001) while it did not increase bleeding complications. Flow chamber experiments revealed that, in contrast to alteplase, abciximab efficiently limits thrombus accretion from flowing blood by blocking platelet aggregation. Our results underscore a key role for platelet aggregation and the potential of Glycoprotein IIb/IIIa antagonists as a rescue therapy in post-MT immediate reocclusion.
Disciplines :
Neurology
Author, co-author :
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques ; Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
Loyau, Stephane; Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
Labreuche, Julien; Lille, France
Taylor, Guillaume; Rothschild Foundation Hospital, Intensive Care Department, Paris, France
Maier, Benjamin; Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France ; Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
Piotin, Michel; Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France ; Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
Blanc, Raphael; Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France ; Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
Escalard, Simon; Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
Di Meglio, Lucas; Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
Ben Maacha, Malek; Clinical Research Unit, Rothschild Foundation Hospital, Paris, France
Redjem, Hocine; Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
Smajda, Stanislas; Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
Ciccio, Gabriele; Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
Hébert, Solène; Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France
Sabben, Candice; Rothschild Foundation Hospital, Neurology Department, Paris, France
Jandrot-Perrus, Martine; Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
Mazighi, Mikael; Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France ; Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France ; Université De Paris, France ; DHU Neurovasc
Ho-Tin-Noé, Benoit; Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France
Desilles, Jean-Philippe; Rothschild Foundation Hospital, Interventional Neuroradiology Department, Paris, France ; Laboratory of Vascular Translational Science, U1148 INSERM, Université De Paris, Paris, France ; Université De Paris, France
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