Frontiers in Neurology (Apr 2025)

Safety, efficacy and timing of antithrombotic therapy in emergency stenting of acute stroke patients with tandem lesions, German multicenter data-analysis

  • Fee Keil,
  • Simon Stahn,
  • Ferdinand O. Bohmann,
  • Patrick Samp,
  • Leonhard Mann,
  • Lukas Bersch,
  • Waltraud Pfeilschifter,
  • Felix Bode,
  • Marios-Nikos Psychogios,
  • Jan-Hendrik Schaefer,
  • Christian Grefkes,
  • Elke Hattingen,
  • Joachim Berkefeld,
  • Christophe T. Arendt,
  • German Stroke Registry – Endovascular Treatment (GSR-ET) Investigators,
  • Joachim Röther,
  • Bernd Eckert,
  • Michael Braun,
  • Gerhard F. Hamann,
  • Eberhard Siebert,
  • Christian H Nolte,
  • Martina Petersen,
  • Lars Krause,
  • Tobias Boeckh-Behrens,
  • Silke Wunderlich,
  • Maximilian Schell,
  • Jens Fiehler,
  • Götz Thomalla,
  • Fabian Flottmann,
  • Anna Alegiani,
  • Franziska Dorn,
  • Gabor Petzold,
  • Jan Hendrik Schäfer,
  • Fee Keil,
  • Hanna Zimmermann,
  • Steffen Tiedt,
  • Lars Kellert,
  • Ulrike Ernemann,
  • Sven Poli,
  • Arno Reich,
  • Omid Nikoubashman,
  • Ilko L Maier,
  • Marielle S Ernst,
  • Mario Abruscato,
  • Sven Thonke,
  • Arman Gregor,
  • Evdokia Evangelidou,
  • Peter Schellinger,
  • Jan Borggrefe

DOI
https://doi.org/10.3389/fneur.2025.1554691
Journal volume & issue
Vol. 16

Abstract

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BackgroundAntithrombotic therapy of acute stroke patients with tandem lesions and emergent carotid artery stenting (CAS) is still a matter of controversial debates. The lack of evidence from dedicated studies favors a variety of clinical practices. The aim of this study was to use German Stroke Registry (GSR) data of selected high-volume centers to analyze the spectrum of antithrombotic regimens and their influence on complication rates and clinical outcome.MethodsWe analyzed the GSR-subgroup of patients with tandem lesions treated with a combination of thrombectomy and carotid artery stenting between 2015 and 2020 in experienced stroke centers which included all consecutive cases, and which were willing to share clinical records in addition to registry data. Statistical analyses of kind and onset of CAS-specific antiplatelet therapy (APT) were used to determine the influence of dual APT (DAPT) on clinical outcome and stent-related complications.ResultsIn total, 223 patients with tandem lesions treated by stenting and thrombectomy were included. In the periinterventional phase 68 patients (30.5%) had an aggressive DAPT with double antiplatelets (DAPT; 23.7%) given via gastral tube or with GPIIb-IIIa inhibitors intravenously as bridging (13.9%). In the post-interventional phase, the rate of DAPT increased from 38.6% on day one to 65% from day two. Already on day one, the effect of DAPT on the rate of good clinical outcome mRS (modified Rankin Scale) 0–2 at 90 days (n = 86/223; 38.5%) was significant (p < 0.007), and compared with other APT regimens early continuous DAPT from the first postinterventional day increased the odds up to 79.4% (n = 27/34). DAPT during hospitalization showed no increased risk of symptomatic hemorrhage, while post-hospital use reduced stent occlusion (p = 0.016).ConclusionOnly a minority of the examined GSR patients with tandem lesions had an effective APT during the periinterventional phase up to day 1. Early postinterventional DAPT significantly increased the rate of good clinical outcome and reduced the rate of occlusive stent thrombosis without increasing risks of symptomatic hemorrhage. The apparent lack of standards and moderate rates of good clinical outcomes shows room for improvement and the necessity of further studies.

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