Impact of Prior Antiplatelet Therapy on Outcomes After Endovascular Therapy for Acute Stroke: Endovascular Treatment in Ischemic Stroke Registry Results
Authors: Couture Marie , Finitsis Stephanos , Marnat Gaultier , Richard Sébastien , Bourcier Romain , Constant-dits-Beaufils Pacôme , Dargazanli Cyril , Arquizan Caroline , Mazighi Mikaël , Blanc Raphaël , Eugène François , Vannier Stéphane , Spelle Laurent , Denier Christian , Touzé Emmanuel , Barbier Charlotte , Saleme Suzana , Macian Francisco , Rosso Charlotte , Clarençon Frédéric , Naggara Olivier , Turc Guillaume , Ozkul-Wermester Ozlem , Papagiannaki Chrysanthi , Viguier Alain , Cognard Christophe , Lebras Anthony , Evain Sarah , Wolff Valérie , Pop Raoul , Timsit Serge , Gentric Jean-Christophe , Bourdain Frédéric , Veunac Louis , Lapergue Bertrand , Consoli Arturo , Gory Benjamin , Sibon Igor , Piotin Michel , Redjem Hocine , Escalard Simon , Dessilles Jean-Philippe , Delvoye François , Smajda Stanislas , Maier Benjamin , Solène Hebert , Obadia Mikael , Sabben Candice , Seners Pierre , Raynouard Igor , Corabianu Ovide , de Broucker Thomas , Manchon Eric , Taylor Guillaume , Ben Maacha Malek , Thion Laurie-Anne , Lecler Augustin , Savatovsjy Julien , Wang Adrien , Evrard Serge , Tchikviladze Maya , Ajili Nadia , WeisenburgerLile David , Gorza Lucas , Buard Géraldine , Coskun Oguzhan , Di Maria Federico , Rodesh Georges , Zimatore Sergio , Leguen Morgan , Gratieux Julie , Pico Fernando , Rakotoharinandrasana Haja , Tassan Philippe , Poll Roxanna , Marinier Sylvie , Gariel Florent , Barreau Xavier , Berge Jérôme , Menegon Patrice , Lucas Ludovic , Olindo Stéphane , Renou Pauline , Sagnier Sharmila , Poli Mathilde , Debruxelles Sabrina , Rouanet François , Tourdias Thomas , Liegey Jean-Sebastien , Briau Pierre , Pangon Nicolas , Detraz Lili , Daumas-Duport Benjamin , Alexandre Pierre-Louis , Roy Monica , Lenoble Cédric , Desal Hubert , Guillon Benoît , de Gaalon Solène , Preterre Cécile , Bracard Serge , Anxionnat René , Braun Marc , Derelle Anne-Laure , Liao Liang , Tonnelet Romain , Liao François , Zhu Emmanuelle , Schmitt Sophie , Planel Sébastien , Richard Lisa , Humbertjean Gioia , Mione Jean-Christophe , Lacour Nolwenn , Riou-Comte Gérard , Audibert Marcela , Voicu Lionel , Alb Marie , Reitter Madalina , Brezeanu Agnès , Masson Adriana , Tabarna Iona , Podar Sarah , Guy Fatiha , Bechiri Fatiha , Mounayer Charbel , Rouchaud Aymeric , Gimenez Laetitia , Cosnard Alexandre , Costalat Vincent , Gascou Grégory , Lefèvre Pierre-Henri , Derraz Imad , Riquelme Carlos , Gaillard Nicolas , Mourand Isabelle , Corti Lucas , Cagnazzo Federico , ter Schiphorst Adrien , Ferre Jean-Christophe , Raoult Hélène , Ronziere Thomas , Lassale Maria , Paya Christophe , Gauvrit Jean-Yves , Tracol Clément , Maurice Sophie Langnier-Lemercier, Axelle , Cochennec Sabrina , Pinault Mélanie , Shotar Eimad , Sourour Nader , Lenck Stéphanie , Premat Kévin , Anne Léger Yves Samson , Crozier Sophie , Baronnet Flore , Alamowitch Sonia , Bottin Laure , Yger Mathon , Degos Vincent , Chassin Olivier , Chalumeau Vanessa , Caroff Jildaz , Chassin Olivier , Venditti Laura , Sarov Mariana , Legris Nicolas , Hassen Wagih Ben , Boulouis Grégoire , Rodriguez-Régent Christine , Trystram Denis , Kerleroux Basile , Seners Pierre , Domigo Valérie , Lamy Catherine , Birchenall Julia , Isabel Clothilde , Lun François , Januel Anne Christine , Olivot Jean-Marc , Raposo Nicolas , Bonneville Fabrice , Albucher Jean François , Calviere Lionel , Darcourt Jean , Bellanger Guillaume , Tall Philippe , Schneckenburger Romain , Boulanger Marion , Cogez Julien , Guettier Sophie , Gauberti Maxime , Ognard Julien , Mathias Merrien. Francois , Wermester Ozlem Ozku , Massardier Evelyne , Triquenot Aude , Lefebvre Margeaux , Bernady Patricia , Lagoarde-Segot Laurent , Cailliez Hélène , Higue David , Quenardelle Veronique , Lauer Valerie , Gheoca Roxana , Pierre-Paul Irene , Beaujeux Remy , Mihoc Dan , Manisor Monica , Pottecher Julien , Meyer Alain , Chamaraux-Tran Thiên-Nga , Le Bras Anthony , Le Guen Arnaud , Nighoghossian Norbert , Riva Roberto , Eker Omer , turjman Francis , Derex Laurent , Cho Tae-Hee , Mechtouff Laura , Claire Lukaszewicz Anne , Philippeau Frédéric , Cakmak Serkan , Blanc-Lasserre Karine , Vallet Anne-Evelyne 
Published: September 2021

Background and Purpose:
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.

Methods:
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.

Results:

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.

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