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Impact of Prior Antiplatelet Therapy on Outcomes After Endovascular Therapy for Acute Stroke: Endovascular Treatment in Ischemic Stroke Registry Results

2021; Lippincott Williams & Wilkins; Volume: 52; Issue: 12 Linguagem: Inglês

10.1161/strokeaha.121.034670

1524-4628

Marie Couture, Stephanos Finitsis, Gaultier Marnat, Sébastien Richard, Romain Bourcier, Pacôme Constant Dit Beaufils, Cyril Dargazanli, Caroline Arquizan, Mikaël Mazighi, Raphaël Blanc, François Eugène, Stéphane Vannier, Laurent Spelle, Christian Denier, Emmanuel Touzé, Charlotte Barbier, Suzana Saleme, Francisco Macian, Charlotte Rosso, Frédéric Clarençon, Olivier Naggara, Guillaume Turc, Ozlem Ozkul-Wermester, Chrysanthi Papagiannaki, Alain Viguier, Christophe Cognard, Anthony Lebras, Sarah Evain, Valérie Wolff, Raoul Pop, Serge Timsit, Jean‐Christophe Gentric, Frédéric Bourdain, Louis Veunac, Bertrand Lapergue, Arturo Consoli, Benjamin Gory, Igor Sibon, Michel Piotin, Hocine Redjem, Simon Escalard, Jean-Philippe Dessilles, François Delvoye, Stanislas Smajda, Benjamin Maïer, Hebert Solène, Mikael Obadia, Candice Sabben, Pierre Seners, Igor Raynouard, Ovide Corabianu, T. de Broucker, Eric Manchon, Guillaume Taylor, Malek Ben Maacha, Laurie-Anne Thion, Augustin Lecler, Julien Savatovsjy, Adrien Wang, Serge Evrard, Maya Tchikviladze, Nadia Ajili, David Weisenburger‐Lile, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Federico Di Maria, Georges Rodesh, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier, Florent Gariel, Xavier Barreau, Jérôme Berge, Patrice Ménégon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, François Rouanet, Thomas Tourdias, Jean-Sébastien Liegey, Pierre Briau, Nicolas Pangon, Lili Détraz, Benjamin Daumas-Duport, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre, Serge Bracard, René Anxionnat, Marc Braun, Anne-Laure Derelle, Liang Liao, Romain Tonnelet, François Liao, E Zhu, Sophie Schmitt, Sébastien Planel, L. Richard, Gioia Humbertjean, Jean-Christophe Mione, Nolwenn Lacour, Gérard Riou-Comte, Marcela Audibert, L Voicu, M. Alb, M. Reitter, Agnès Brezeanu, A. De Masson, Iona Tabarna, Sarah Podar, Fatiha Guy, Fatiha Bechiri, Charbel Mounayer, Aymeric Rouchaud, Laëtitia Gimenez, Alexandre Cosnard, Vincent Costalat, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Federico Cagnazzo, Adrien ter Schiphorst, Jean‐Christophe Ferré, Hélène Raoult, Thomas Ronzière, Maria Lassale, Christophe Paya, Jean-Yves Gauvrit, Clément Tracol, Axelle Maurice Sophie Langnier-Lemercier, Sabrina Cochennec, Mélanie Pinault, Eimad Shotar, Nader Sourour, Stéphanie Lenck, Kévin Premat, Yves Samson Anne Léger, Sophie Crozier, Flore Baronnet, Sonia Alamowitch, Laure Bottin, Mathon Yger, Vincent Degos, Olivier Chassin, Vanessa Chalumeau, Jildaz Caroff, Olivier Chassin, Laura Venditti, Mariana Sarov, Nicolas Legris, Wagih Ben Hassen, Grégoire Boulouis, Christine Rodriguez-Régent, D. Trystram, Basile Kerleroux, Pierre Seners, Valérie Domigo, Catherine Lamy, Julia Birchenall, Clothilde Isabel, François Lun, Anne Christine Januel, Jean‐Marc Olivot, Nicolas Raposo, Fabrice Bonneville, Jean François Albucher, Lionel Calvière, Jean Darcourt, Guillaume Bellanger, Philippe Tall, Romain Schneckenburger, Marion Boulanger, Julien Cogez, Sophie Guettier, Maxime Gauberti, Julien Ognard, Francois Mathias Merrien, Ozlem Ozku Wermester, Evelyne Massardier, Aude Triquenot, Margeaux Lefebvre, Patricia Bernady, Laurent Lagoarde-Segot, Hélène Cailliez, David Higue, Véronique Quenardelle, Valérie Lauer, Roxana Gheoca, Irène Pierre-Paul, Rémy Beaujeux, Dan Mihoc, Monica Manisor, Julien Pottecher, Alain Meyer, Thiên‐Nga Chamaraux‐Tran, Anthony Le Bras, Arnaud Le Guen, Norbert Nighoghossian, Roberto Riva, Omer Eker, Francis Turjman, Laurent Derex, Tae‐Hee Cho, Laura Mechtouff, Anne Claire Lukaszewicz, Frédéric Philippeau, Serkan Cakmak, Karine Blanc‐Lasserre, Anne‐Evelyne Vallet,

Antiplatelet Therapy and Cardiovascular Diseases

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.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.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.Prior APT does not influence angiographic and functional outcomes following endovascular therapy and should not be taken into account for acute revascularization strategies.