Impact of Antiplatelet Therapy During Endovascular Therapy for Tandem Occlusions
Authors: Zhu François , Anadani Mohammad , Labreuche Julien , Spiotta Alejandro , Turjman Francis , Piotin Michel , Steglich-Arnholm Henrik , Holtmannspötter Markus , Taschner Christian , Eiden Sebastian , Haussen Diogo C. , Nogueira Raul G. , Papanagiotou Panagiotis , Boutchakova Maria , Siddiqui Adnan H. , Lapergue Bertrand , Dorn Franziska , Cognard Christophe , Killer-Oberpfalzer Monika , Mangiafico Salvatore , Ribo Marc , Psychogios Marios N. , Labeyrie Marc-Antoine , Mazighi Mikael , Biondi Alessandra , Anxionnat René , Bracard Serge , Richard Sébastien , Gory Benjamin , Grossberg Jonathan Andrew , Guenego Adrien , Darcourt Julien , Vukasinovic Isabelle , Pomero Elisa , Davies Jason , Renieri Leonardo , Hecker Corentin , Muchada Maria Muchada , Consoli Arturo , Rodesch Georges , Houdart Emmanuel , Lockau Johanna , Kastrup Andreas , Blanc Raphaël , Redjem Hocine , Behme Daniel , Shallwani Hussain , Christopher Maurer , Mione Gioia , Humbertjean Lisa , Lacour Jean-Christophe , Riou-Comte Nolwenn , Derelle Anne-Laure , Tonnelet Romain , Liao Liang 
Published: March 2020

Background and Purpose—
Antiplatelet agents could be used in the setting of endovascular therapy for tandem occlusions to reduce the risk of de novo intracranial embolic migration, reocclusion of the extracranial internal carotid artery lesion, or in-stent thrombosis in case of carotid stent placement but have to be balanced with the intracerebral hemorrhagic transformation risk. In this study, we aim to investigate the impact of acute antiplatelet therapy administration on outcomes during endovascular therapy for anterior circulation tandem occlusions.

Methods—
This is a retrospective analysis of a collaborative pooled analysis of 11 prospective databases from the multicenter observational TITAN registry (Thrombectomy in Tandem Lesions). Patients were divided into groups based on the number of antiplatelet administered during endovascular therapy. The primary outcome was favorable outcome, defined as a modified Rankin Scale score of 0 to 2 at 90 days.

Results—

This study included a total of 369 patients; 145 (39.3%) did not receive any antiplatelet agent and 224 (60.7%) received at least 1 antiplatelet agent during the procedure. Rate of favorable outcome was nonsignificantly higher in patients treated with antiplatelet therapy (58.3%) compared with those treated without antiplatelet (46.0%; adjusted odds ratio, 1.38 [95% CI, 0.78–2.43];
P
=0.26). Rate of 90-day mortality was significantly lower in patients treated with antiplatelet therapy (11.2% versus 18.7%; adjusted odds ratio, 0.47 [95% CI, 0.22–0.98];
P
=0.042), without increasing the risk of any intracerebral hemorrhage. Successful reperfusion (modified Thrombolysis in Cerebral Ischemia score 2b-3) rate was significantly better in the antiplatelet therapy group (83.9% versus 71.0%; adjusted odds ratio, 1.89 [95% CI, 1.01–3.64];
P
=0.045).

Conclusions—
Administration of antiplatelet therapy during endovascular therapy for anterior circulation tandem occlusions was safe and was associated with a lower 90-day mortality. Optimal antiplatelet therapy remains to be assessed, especially when emergent carotid artery stenting is performed. Further randomized controlled trials are needed.