Impact of Prior Antiplatelet Therapy on Outcomes After Endovascular Therapy for Acute Stroke: Endovascular Treatment in Ischemic Stroke Registry Results.
[en] [en] BACKGROUND AND PURPOSE: The influence of prior antiplatelet therapy (APT) uses on the outcomes of patients with acute ischemic stroke treated with endovascular therapy is unclear. We compared procedural and clinical outcomes of endovascular therapy in patients on APT or not before stroke onset.
METHODS: We analyzed 2 groups from the ongoing prospective multicenter Endovascular Treatment in Ischemic Stroke registry in France: patients on prior APT (APT+) and patients without prior APT (APT-) treated by endovascular therapy, with and without intravenous thrombolysis. Multilevel mixed-effects logistic models including center as random effect were used to compare angiographic (rates of reperfusion at the end of procedure, procedural complications) and clinical (favorable and excellent outcome, 90-day all-cause mortality, and hemorrhagic complications) outcomes according to APT subgroups. Comparisons were adjusted for prespecified confounders (age, admission National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT Score, intravenous thrombolysis, and time from onset to puncture), as well as for meaningful baseline between-group differences.
RESULTS: A total of 2939 patients were analyzed, of whom 877 (29.8%) were on prior APT. Patients with prior APT were older, had more frequent vascular risk factors, cardioembolic stroke mechanism, and prestroke disability. Rates of complete reperfusion (37.9% in the APT- group versus 42.7 % in the APT+ group; aOR, 1.09 [95% CI, 0.88-1.34]; P=0.41) and periprocedural complication (16.9% versus 13.3%; aOR, 0.90 [95% CI, 0.7-1.2]; P=0.66) did not differ between the two groups. Symptomatic intracerebral hemorrhage (aOR, 0.93 [95% CI, 0.63-1.37]; P=0.73), 3 months favorable clinical outcome (modified Rankin Scale score of 0-2; aOR, 0.98 [95% CI, 0.77-1.25]; P=0.89), and mortality (aOR, 0.95 [95% CI, 0.72-1.26]; P=0.76) at 90 days did not differ between the groups.
CONCLUSIONS: Prior APT does not influence angiographic and functional outcomes following endovascular therapy and should not be taken into account for acute revascularization strategies.
Disciplines :
Neurology
Author, co-author :
Couture, Marie ; Department of Neurology, Stroke Center (M.C., I.S.), University Hospital of Bordeaux, France
Finitsis, Stephanos ; Interventional and Diagnostic Neuroradiology Department, AHEPA University Hospital, Thessaloniki, Greece (S.F
Marnat, Gaultier ; Department of Diagnostic and Interventional Neuroradiology (G.M.), University Hospital of Bordeaux, France
Richard, Sébastien ; Stroke Unit, Department of Neurology, CHRU-Nancy (S.R.), Université de Lorraine, France ; INSERM U1116, CHRU-Nancy, France (S.R
Bourcier, Romain ; Departments of Neuroradiology (R.B.), University Hospital of Nantes, France
Constant-Dits-Beaufils, Pacôme ; Neurology (P.C.-d.-B.), University Hospital of Nantes, France
Dargazanli, Cyril ; Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France (C.D
Arquizan, Caroline; Department of Neurology, CHRU Gui de Chauliac, Montpellier, France (C.A
Mazighi, Mikaël ; Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.M., R.B
Blanc, Raphaël ; Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France (M.M., R.B
Eugène, François; Department of Neuroradiology, University Hospital of Rennes, France (F.E
Vannier, Stéphane ; Stroke Unit, Department of Neurology, University Hospital of Rennes, France (S.V
Spelle, Laurent ; Neuroradiolology (L.S.), CHU Kremlin Bicêtre, Paris, France
Denier, Christian ; Departments of Neurology (C.D.), CHU Kremlin Bicêtre, Paris, France
Touzé, Emmanuel ; Departments of Neurology (E.T.), CHU Caen, France
Barbier, Charlotte; Neuroradiology (C.B.), CHU Caen, France
Saleme, Suzana ; Diagnostic and Interventional Neuroradiology (S.S), University Hospital of Limoges, France
Macian, Francisco ; Departments of Neurology (F.M.), University Hospital of Limoges, France
Rosso, Charlotte; Departments of Neurology (C.R.), CHU Pitié-Salpétrière, Paris, France
Clarençon, Frédéric ; Neuroradiolology (F.C.), CHU Pitié-Salpétrière, Paris, France
Naggara, Olivier ; Neuroradiolology (O.N.), Hôpital Saint Anne, Paris, France
Turc, Guillaume ; Departments of Neurology (G.T.), Hôpital Saint Anne, Paris, France
Ozkul-Wermester, Ozlem ; Departments of Neurology (O.O.-W.), CHU Rouen, France
Papagiannaki, Chrysanthi ; Neuroradiolology (C.P.), CHU Rouen, France
Viguier, Alain ; Departments of Neurology (A.V.), CHU Toulouse, France
Cognard, Christophe ; Neuroradiolology (C.C.), CHU Toulouse, France
Lebras, Anthony ; Departments of Neurology (A.L.), CH Bretagne Atlantique, Vannes, France
Evain, Sarah ; Neuroradiolology (S.E.), CH Bretagne Atlantique, Vannes, France
Wolff, Valérie; Departments of Neurology (V.W.), CHU Strasbourg, France
Pop, Raoul ; Neuroradiolology (R.P.), CHU Strasbourg, France
Timsit, Serge ; Departments of Neurology (S.T.), CHU Brest, France
Gentric, Jean-Christophe; Neuroradiolology (J.-C.G.), CHU Brest, France
Bourdain, Frédéric; Departments of Neurology (F.B.), CH Côte Basque, Bayonne, France
Veunac, Louis; Neuroradiolology (L.V.), CH Côte Basque, Bayonne, France
Lapergue, Bertrand; Department of Neurology, Foch Hospital (B.L.), Versailles Saint-Quentin en Yvelines University, Suresnes, France
Consoli, Arturo ; Department of Diagnostic and Interventional Neuroradiology (A.C.), Versailles Saint-Quentin en Yvelines University, Suresnes, France
Gory, Benjamin ; Department of Diagnostic and Therapeutic Neuroradiology, CHRU-Nancy (B.G.), Université de Lorraine, France ; IADI, INSERM U1254 (B.G.), Université de Lorraine, France
Sibon, Igor ; Department of Neurology, Stroke Center (M.C., I.S.), University Hospital of Bordeaux, France
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques
Language :
English
Title :
Impact of Prior Antiplatelet Therapy on Outcomes After Endovascular Therapy for Acute Stroke: Endovascular Treatment in Ischemic Stroke Registry Results.
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