Multicenter comparison of antiplatelet treatment strategies for urgent/emergent neuroendovascular stenting.
Document Type
Article
Publication Title
Interventional neuroradiology
Abstract
BACKGROUND: Emergent neuroendovascular stenting presents challenges for the utilization of antiplatelet agents.
METHODS: This was a multicenter, retrospective cohort of patients who underwent emergent neuroendovascular stenting. The primary endpoints were thrombotic and bleeding events in relation to the timing of antiplatelet administration, route of administration, and choice of intravenous (IV) agent and the study investigated practice variability in antiplatelet utilization.
RESULTS: Five-hundred and seventy patients were screened across 12 sites. Of those, 167 were included for data analysis. For patients who presented with ischemic stroke, artery dissection and emergent internal carotid artery (ICA) stenting who received an antiplatelet agent prior to or during the procedure, 57% were given an IV antiplatelet agent; for patients who were given an antiplatelet agent after the procedure, 96% were given an oral agent. For patients who presented for aneurysm repair and received an antiplatelet agent prior to or during the procedure, 74% were given an IV agent; patients who were given an antiplatelet agent after the completion of the procedure were given an oral antiplatelet agent 90% of the time. In patients who presented with ischemic stroke, artery dissection and emergent ICA stenting who received oral antiplatelet agents post-procedure were more likely to have thrombotic events compared to those who received oral antiplatelet agents prior to or during the procedure (29% vs 9%;
CONCLUSION: The optimal timing of antiplatelet administration in relation to stent placement and route of administration of antiplatelet agents is unclear. Timing and route of administration of antiplatelet agents may have an effect on thrombosis in emergent neuroendovascular stenting. Significant practice variation exists in antiplatelet agent utilization in emergent neuroendovascular stenting.
First Page
15910199231180003
Last Page
15910199231180003
DOI
10.1177/15910199231180003
Publication Date
7-4-2023
Recommended Citation
Holden D, May CC, Robbins BT, Cook AM; Neurocritical Care Pharmacy Section Research Group:; Jung S, Smetana KS, Roels C, Harlan SS, Keegan S, Brophy G, Al Mohaish S, Sandler M, Spetz S, Wohlfarth K, Owusu-Guha J, Buschur P, Hetrick E, Dombrowski K, Glover J, Levesque M, Dingman S, Hussain M. Multicenter comparison of antiplatelet treatment strategies for urgent/emergent neuroendovascular stenting. Interv Neuroradiol. 2023 Jul 4:15910199231180003. doi: 10.1177/15910199231180003. Epub ahead of print. PMID: 37402388.