Outcomes of antiplatelet therapy before endovascular treatment of acute large vessel occlusion: Data from the ANGEL-ACT registry - 14/02/24

Doi : 10.1016/j.neurad.2024.02.001

Dapeng Sun ^a,^{^{#
These authors contributed equally to the manuscript.}}, Shuo Li ^a,^{^{#
These authors contributed equally to the manuscript.}}, Raynald ^a, Xiaochuan Huo ^b, Baixue Jia ^a, Xu Tong ^a, Anxin Wang ^c, Ning Ma ^a, Feng Gao ^a, Dapeng Mo ^a, Thanh N Nguyen ^d, Zhongrong Miao ^a,^⁎
on behalf of the
ANGEL-ACT study group
^a Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
^b Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
^c China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
^d Department of Neurology, Radiology, Boston Medical Center, Boston, Massachusetts, USA

^⁎Corresponding author.

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Highlights

•	What is already known on this topic

•	Whether prior oral single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT) could modify the functional outcomes of endovascular treatment (EVT) for patients with large vessel occlusion (LVO) remains unknown.

•	What this study adds

•	DAPT within 24 hours before EVT decreased the number of passes and procedure duration, without increasing SICH risk as compared to non-APT. Clinical outcomes at 90 days were similar between groups.

•	How this study might affect research, Practice, or policy

•	Our findings based on a large multicenter real-world registry added additional data of APT before EVT for LVO to the global data. Further RCTs are warranted to investigate the potential efficacy and safety of oral APT before EVT.

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Abstract

Objectives

To investigate whether single or dual antiplatelet therapy (SAPT or DAPT) within 24 hours before endovascular treatment (EVT) could improve the clinical outcomes of patients with large vessel occlusion (LVO).

Methods

Patients from the ANGEL-ACT registry were divided into antiplatelet therapy (APT) and non-APT groups. The APT group was divided into SAPT and DAPT groups. Outcome measurement included 90-day modified Rankin Scale (mRS) distribution, change in the NIHSS at 7 days or discharge, number of passes, modified first pass effect (mFPE), symptomatic intracranial hemorrhage (SICH), and mortality within 90 days. To compare the outcomes, we performed multivariable analyses by adjusting for the propensity score calculated by the logistic regression model.

Results

Of 1611 patients, 1349 were in the non-APT group, while 262 (16.3 %) were in the APT group (122 [46.6 %] received SAPT, 140 [53.4 %] received DAPT). APT, SAPT or DAPT were not associated with a shift to better outcomes (non-APT vs. APT, 3[0–5] vs. 3[0–5], common odds ratio [OR], 1.04, 95 %confidence interval [CI]:0.82–1.34, P = 0.734). DAPT was associated with mFPE (OR,2.05, 95 %CI:1.39–3.01, P<0.001), more NIHSS reduction at 7 days or discharge (β, -2.13, 95 %CI: -4.02–-0.24, P = 0.028), lower number of passes (β, -0.40, 95 %CI: -0.68–-0.12, P=0.006), and shorter procedure duration (β, -12.4, 95 %CI: -23.74–-1.05, P = 0.032) without increasing odds of successful recanalization, PH within 24 hours and mortality with 90 days .

Conclusions

APT before MT for AIS due to LVO does not affect clinical outcome in 90 days despite a tendency to reduce MT procedure time and number of passes. APT before MT in LVO does not increase SICH or mortality rates.

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Keywords : Large vessel occlusion, Endovascular treatment, Antiplatelet therapy