Platelet inhibition strategies in rescue stenting after failed thrombectomy: a large retrospective multicenter registry
: Anastasiou Aikaterini; Brehm Alex; Kaesmacher Johannes; Mujanovic Adnan; de Dios Lascuevas Marta; Carmona Fuentes Tomás; López-Frías Alfonso; Hidalgo Valverde Blanca; Berlis Ansgar; Maurer Christoph J.; Nguyen Thanh N.; Abdalkader Mohamad; Klein Piers; Thevoz Guillaume; Michel Patrik; Bartolini Bruno; Kaschner Marius; Weiss Daniel; Alexandre Andrea M.; Pedicelli Alessandro; Machi Paolo; Bernava Gianmarco; Kuwahara Shuntaro; Uchida Kazutaka; Wenderoth Jason; Joshi Anirudh; Karwacki Grzegorz; Bolognese Manuel; Tessitore Agostino; Vinci Sergio Lucio; Cervo Amedeo; Rollo Claudia; Hui Ferdinand; Mozumder Aaisha Siddiqua; Romano Daniele Giuseppe; Frauenfelder Giulia; Goyal Nitin; Batra Vivek; Inoa Violiza; Cognard Christophe; Hoferica Matúš; Rautio Riitta; Kaiser Daniel P. O.; Gerber Johannes C.; Clarke Julian; Levitt Michael R.; Wolf Marcel N.; Othman Ahmed E.; Scarcia Luca; Kalsoum Erwah; Melancia Diana; Sousa Diana Aguiar de; Ganimede Maria Porzia; Semeraro Vittorio; Giordano Flavio; Muto Massimo; Katsanos Aristeidis; Bonala Umesh; Tuladhar Anil M.; Jenniskens Sjoerd F. M.; Hellstern Victoria; Kleffner Ilka; Remida Paolo; Diamanti Susanna; Renieri Leonardo; Ballabio Elena; Valvassori Luca; Rommers Nikki; Katan Mira; Schulze-Zachau Victor; Psychogios Marios-Nikos
Publisher: SAGE Publications
: 2025
: Therapeutic Advances in Neurological Disorders
: 17562864251360913
: 18
: 1756-2864
: 1756-2864
DOI: https://doi.org/10.1177/17562864251360913
: https://doi.org/10.1177/17562864251360913
: https://research.utu.fi/converis/portal/detail/Publication/504593740
Background: Rescue stenting (RS) is a bailout strategy for failed thrombectomy. Optimal platelet inhibition strategy after RS remains unclear.
Objectives: We aimed to describe and compare different platelet inhibition strategies during/after RS.
Design: Retrospective cohort study across 34 international centers.
Methods: Patients with large vessel occlusion and RS after failed thrombectomy (2019-2023) were included. Periprocedural and postprocedural platelet inhibition strategies were described and compared, focusing on glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors, single antiplatelet therapy (SAPT), and dual antiplatelet therapy (DAPT). We assessed the effects of platelet inhibition strategy and potentially covariates on the primary outcome of 90-day modified Rankin Scale (mRS) using ordinal shift analysis with proportional odds models.
Results: RS was performed in 589 patients (mean age 67.9 years, 60.8% male). Numerous combinations of platelet inhibitors were administered. Periprocedural GPIIb/IIIa inhibitors were used in 61.5% of patients. Postprocedural DAPT was administered to 80.5% and SAPT to 13.3%. Functional independence (mRS 0-2) was achieved in 40.7%, while 26.3% died within 90 days. Stent occlusion occurred in 20.5%, with 67.6% of these occlusions within 24 h. Postprocedural stent-occlusion was independently associated with worse functional outcome at 90 days (OR 4.1, 95% CI 2.3-7.2, p < 0.001). No significant association between periprocedural GPIIb/IIIa inhibitors, and 90-day mRS or stent occlusion was found. Postprocedural SAPT was associated with worse functional outcomes (adjusted odds ratio (aOR) 2.4, 95% CI 1.1-5.0, p = 0.02), higher mortality (aOR 2.1, 95% CI 1.05-4.0, p = 0.03), and increased stent occlusion rates (aOR 4.8, 95% CI 2.3-9.7, p < 0.001) compared to postprocedural DAPT. Symptomatic intracranial hemorrhage occurred in 6.8% of patients, with no significant difference between antiplatelet regimens.
Conclusion: Extensive heterogeneity exists in platelet inhibition strategies following RS. Stent occlusion is associated with worse clinical outcomes, and the first 24 h post-RS are critical for stent patency. Compared to SAPT, DAPT was associated with better functional outcome, lower mortality, and lower stent occlusion rates.
:
Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: No project-specific funding was received for this study. V.S.-Z. is recipient of a research grants from Basel University, Bangerter-Rhyner-Foundation Basel and Freiwillige Akademische Gesellschaft Basel, Basel, Switzerland.
