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Purpose <p>Mechanical thrombectomy (MT) with emergent carotid artery stenting (eCAS) has been suggested to provide greater benefits for patients with tandem lesions (TL), but there is uncertainty about the most appropriate peri-procedural antiplatelet therapy for patients at higher risk of brain hemorrhage. This study aimed to assess the safety of intravenous thrombolysis (IVT) in patients with acute TL undergoing MT with eCAS.</p> Methods <p>The databases of 17 stroke centers were retrospectively screened for consecutive patients with acute TL who underwent MT and eCAS. Propensity score matching (PSM) was used to evaluate the safety of IVT, balancing for peri-procedural antiplatelet therapies. Primary outcome measures were the occurrence of parenchymal hemorrhage (PH) type 2 and mortality within 90 days from the index event. Secondary outcome measures included occurrence of PH type 1, extracranial bleeding events, early stent thrombosis, efficient recanalization after MT and the 90-day functional outcome.</p> Results <p>Among 560 enrolled patients, 47.3% received IVT prior to the endovascular procedure. After PSM, there was no significant difference between patients treated with and without IVT under different antiplatelet regimens concerning the rates of PH type 2 (5.2% versus 6.9%, <i>p</i> = 0.7, respectively) and of mortality of any cause (7.5% vs. 8.2%, <i>p</i> = 0.8). In addition, IVT did not impact recanalization rates or clinical outcome.</p> Conclusions <p>The safety of MT with eCAS in acute TL is not affected by prior IVT. Furthermore, IVT does not ameliorate recanalization rates and clinical outcome. These findings are exploratory and require validation through future randomized controlled studies.</p>

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Safety of emergent carotid stenting after thrombolysis: a multicenter retrospective matched analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月21日

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  • Francesca Colò,
  • Andrea M. Alexandre,
  • Valerio Brunetti,
  • Francesco Arba,
  • Luca Scarcia,
  • Alessandro Pedicelli,
  • Mariangela Piano,
  • Maria Ruggiero,
  • Joseph D. Gabrieli,
  • Valerio Da Ros,
  • Daniele Romano,
  • Riccardo Russo,
  • Anna Cavallini,
  • Guido Bigliardi,
  • Antonio A. Caragliano,
  • Maria P. Ganimede,
  • Giancarlo Salsano,
  • Pietro Panni,
  • Emilio Lozupone,
  • Sabrina Anticoli,
  • Monica Ferrante,
  • Andrea Zini,
  • Danilo Toni,
  • Thanh N. Nguyen,
  • Frédéric Clarençon,
  • Aldobrando Broccolini

摘要

Purpose

Mechanical thrombectomy (MT) with emergent carotid artery stenting (eCAS) has been suggested to provide greater benefits for patients with tandem lesions (TL), but there is uncertainty about the most appropriate peri-procedural antiplatelet therapy for patients at higher risk of brain hemorrhage. This study aimed to assess the safety of intravenous thrombolysis (IVT) in patients with acute TL undergoing MT with eCAS.

Methods

The databases of 17 stroke centers were retrospectively screened for consecutive patients with acute TL who underwent MT and eCAS. Propensity score matching (PSM) was used to evaluate the safety of IVT, balancing for peri-procedural antiplatelet therapies. Primary outcome measures were the occurrence of parenchymal hemorrhage (PH) type 2 and mortality within 90 days from the index event. Secondary outcome measures included occurrence of PH type 1, extracranial bleeding events, early stent thrombosis, efficient recanalization after MT and the 90-day functional outcome.

Results

Among 560 enrolled patients, 47.3% received IVT prior to the endovascular procedure. After PSM, there was no significant difference between patients treated with and without IVT under different antiplatelet regimens concerning the rates of PH type 2 (5.2% versus 6.9%, p = 0.7, respectively) and of mortality of any cause (7.5% vs. 8.2%, p = 0.8). In addition, IVT did not impact recanalization rates or clinical outcome.

Conclusions

The safety of MT with eCAS in acute TL is not affected by prior IVT. Furthermore, IVT does not ameliorate recanalization rates and clinical outcome. These findings are exploratory and require validation through future randomized controlled studies.