Association of perioperative P2Y12 inhibitor administration with outcomes for tandem occlusion: RESCUE AT-LVO sub-study
BackgroundWe aimed to clarify the association between intraoperative P2Y12 inhibitor administration during EVT and clinical outcomes in patients with anterior circulation TO stroke.MethodsAmong consecutive patients with acute ischemic stroke (AIS) enrolled in the Recovery by Endovascular Salvage for...
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Frontiers Media S.A.
2024-11-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2024.1475882/full |
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| author | Takeshi Yoshimoto Takeshi Yoshimoto Hiroshi Yamagami Hiroshi Yamagami Hiroshi Yamagami Nobuyuki Sakai Kazutaka Uchida Manabu Shirakawa Mikiya Beppu Kazunori Toyoda Yuji Matsumaru Yuji Matsumaru Yasushi Matsumoto Kenichi Todo Mikito Hayakawa Mikito Hayakawa Seigo Shindo Masafumi Morimoto Masataka Takeuchi Hirotoshi Imamura Hiroyuki Ikeda Kanta Tanaka Kanta Tanaka Hideyuki Ishihara Hiroto Kakita Takanori Sano Takanori Sano Hayato Araki Tatsufumi Nomura Fumihiro Sakakibara Shinichi Yoshimura for RESCUE AT-LVO Investigators |
| author_facet | Takeshi Yoshimoto Takeshi Yoshimoto Hiroshi Yamagami Hiroshi Yamagami Hiroshi Yamagami Nobuyuki Sakai Kazutaka Uchida Manabu Shirakawa Mikiya Beppu Kazunori Toyoda Yuji Matsumaru Yuji Matsumaru Yasushi Matsumoto Kenichi Todo Mikito Hayakawa Mikito Hayakawa Seigo Shindo Masafumi Morimoto Masataka Takeuchi Hirotoshi Imamura Hiroyuki Ikeda Kanta Tanaka Kanta Tanaka Hideyuki Ishihara Hiroto Kakita Takanori Sano Takanori Sano Hayato Araki Tatsufumi Nomura Fumihiro Sakakibara Shinichi Yoshimura for RESCUE AT-LVO Investigators |
| author_sort | Takeshi Yoshimoto |
| collection | DOAJ |
| description | BackgroundWe aimed to clarify the association between intraoperative P2Y12 inhibitor administration during EVT and clinical outcomes in patients with anterior circulation TO stroke.MethodsAmong consecutive patients with acute ischemic stroke (AIS) enrolled in the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolic and Atherothrombotic Stroke with Large Vessel Occlusion Registry from 2016 to 2019, those with anterior circulation TOs who underwent EVT were analyzed. These patients were categorized into the following groups: those who received P2Y12 inhibitors during the perioperative period and those who did not receive P2Y12 inhibitors. The outcomes included good functional outcomes, as indicated by a modified Rankin Scale score of 0–2 at 90 days, and the incidence of symptomatic intracranial hemorrhage (SICH) was compared between the two groups. Multivariate logistic regression models were used to assess the association of outcomes with perioperative P2Y12 inhibitor administration. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the group that did not receive P2Y12 inhibitors as the reference. The perioperative period included the period in which antithrombotic therapy was administered immediately before EVT and during the operative period.ResultsWe enrolled 242 patients with AIS with anterior circulation TOs (42 females [17.4%]; median age, 76 [interquartile range, 69–81] years). Patients who received P2Y12 inhibitors during the perioperative period (n = 131) showed a higher frequency of carotid artery stenting than those who did not receive perioperative P2Y12 inhibitors (n = 111; 86.3% vs. 42.3%, p < 0.01). Furthermore, patients who received perioperative P2Y12 inhibitors during the perioperative period had a higher incidence of good functional outcomes than those who did not receive perioperative P2Y12 inhibitors (42.0% vs. 32.4%; adjusted OR: 6.65, 95% CI: 1.88–23.53), with no significant differences between the groups in the incidence of SICH (5.3% vs. 8.1%; OR: 0.44; 95% CI: 0.09–2.09).ConclusionPerioperative administration of P2Y12 inhibitors may be associated with a higher frequency of good functional outcomes in patients undergoing EVT for AIS with anterior circulation TOs. However, since several confounding factors are involved in this sub-analysis of EVT for anterior circulation TOs, further studies are warranted. |
| format | Article |
| id | doaj-art-ce134efa865f4df2a47978d9de0dda70 |
| institution | Kabale University |
| issn | 1664-2295 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj-art-ce134efa865f4df2a47978d9de0dda702024-11-21T06:23:33ZengFrontiers Media S.A.Frontiers in Neurology1664-22952024-11-011510.3389/fneur.2024.14758821475882Association of perioperative P2Y12 inhibitor administration with outcomes for tandem occlusion: RESCUE AT-LVO sub-studyTakeshi Yoshimoto0Takeshi Yoshimoto1Hiroshi Yamagami2Hiroshi Yamagami3Hiroshi Yamagami4Nobuyuki Sakai5Kazutaka Uchida6Manabu Shirakawa7Mikiya Beppu8Kazunori Toyoda9Yuji Matsumaru10Yuji Matsumaru11Yasushi Matsumoto12Kenichi Todo13Mikito Hayakawa14Mikito Hayakawa15Seigo Shindo16Masafumi Morimoto17Masataka Takeuchi18Hirotoshi Imamura19Hiroyuki Ikeda20Kanta Tanaka21Kanta Tanaka22Hideyuki Ishihara23Hiroto Kakita24Takanori Sano25Takanori Sano26Hayato Araki27Tatsufumi Nomura28Fumihiro Sakakibara29Shinichi Yoshimura30for RESCUE AT-LVO InvestigatorsDepartment of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, JapanDepartment of Neurology, National Cerebral and Cardiovascular Center, Suita, JapanDepartment of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, JapanDivision of Stroke Prevention and Treatment, Institute of Medicine, University of Tsukuba, Tsukuba, JapanDepartment of Stroke Neurology, NHO Osaka National Hospital, Osaka, JapanDepartment of Neurosurgery, Seijinkai Shimizu Hospital, Kyoto, JapanDepartment of Neurosurgery, Hyogo Medical University, Nishinomiya, JapanDepartment of Neurosurgery, Hyogo Medical University, Nishinomiya, JapanDepartment of Neurosurgery, Hyogo Medical University, Nishinomiya, JapanDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, JapanDepartment of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, JapanDepartment of Neurosurgery, Institute of Medicine, University of Tsukuba, Tsukuba, JapanDivision of Development and Discovery of Interventional Therapy, Tohoku University Hospital, Sendai, Japan0Stroke Center, Osaka University Graduate School of Medicine, Suita, JapanDepartment of Stroke and Cerebrovascular Diseases, University of Tsukuba Hospital, Tsukuba, Japan1Department of Neurology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan2Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan3Department of Neurosurgery, Yokohama Shintoshi Neurosurgical Hospital, Yokohama, Japan4Department of Neurosurgery, Seisho Hospital, Odawara, Japan5Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan6Department of Neurosurgery, Kurashiki Central Hospital, Kurashiki, JapanDepartment of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan7Stroke Center, Kindai University Hospital, Sayama, Japan8Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, JapanDepartment of Neurosurgery, Hyogo Medical University, Nishinomiya, Japan9Department of Neurosurgery, Japanese Red Cross Ise Hospital, Ise, Japan0Department of Neurosurgery, Mie Prefectural General Medical Center, Yokkaichi, Japan1Department of Neurosurgery, Araki Neurosurgical Hospital, Hiroshima, Japan2Department of Neurosurgery, Ohkawara Neurosurgical Hospital, Muroran, JapanDepartment of Neurosurgery, Hyogo Medical University, Nishinomiya, JapanDepartment of Neurosurgery, Hyogo Medical University, Nishinomiya, JapanBackgroundWe aimed to clarify the association between intraoperative P2Y12 inhibitor administration during EVT and clinical outcomes in patients with anterior circulation TO stroke.MethodsAmong consecutive patients with acute ischemic stroke (AIS) enrolled in the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolic and Atherothrombotic Stroke with Large Vessel Occlusion Registry from 2016 to 2019, those with anterior circulation TOs who underwent EVT were analyzed. These patients were categorized into the following groups: those who received P2Y12 inhibitors during the perioperative period and those who did not receive P2Y12 inhibitors. The outcomes included good functional outcomes, as indicated by a modified Rankin Scale score of 0–2 at 90 days, and the incidence of symptomatic intracranial hemorrhage (SICH) was compared between the two groups. Multivariate logistic regression models were used to assess the association of outcomes with perioperative P2Y12 inhibitor administration. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the group that did not receive P2Y12 inhibitors as the reference. The perioperative period included the period in which antithrombotic therapy was administered immediately before EVT and during the operative period.ResultsWe enrolled 242 patients with AIS with anterior circulation TOs (42 females [17.4%]; median age, 76 [interquartile range, 69–81] years). Patients who received P2Y12 inhibitors during the perioperative period (n = 131) showed a higher frequency of carotid artery stenting than those who did not receive perioperative P2Y12 inhibitors (n = 111; 86.3% vs. 42.3%, p < 0.01). Furthermore, patients who received perioperative P2Y12 inhibitors during the perioperative period had a higher incidence of good functional outcomes than those who did not receive perioperative P2Y12 inhibitors (42.0% vs. 32.4%; adjusted OR: 6.65, 95% CI: 1.88–23.53), with no significant differences between the groups in the incidence of SICH (5.3% vs. 8.1%; OR: 0.44; 95% CI: 0.09–2.09).ConclusionPerioperative administration of P2Y12 inhibitors may be associated with a higher frequency of good functional outcomes in patients undergoing EVT for AIS with anterior circulation TOs. However, since several confounding factors are involved in this sub-analysis of EVT for anterior circulation TOs, further studies are warranted.https://www.frontiersin.org/articles/10.3389/fneur.2024.1475882/fullstroketandem occlusionP2Y12 inhibitorendovascular therapycarotid artery stenting |
| spellingShingle | Takeshi Yoshimoto Takeshi Yoshimoto Hiroshi Yamagami Hiroshi Yamagami Hiroshi Yamagami Nobuyuki Sakai Kazutaka Uchida Manabu Shirakawa Mikiya Beppu Kazunori Toyoda Yuji Matsumaru Yuji Matsumaru Yasushi Matsumoto Kenichi Todo Mikito Hayakawa Mikito Hayakawa Seigo Shindo Masafumi Morimoto Masataka Takeuchi Hirotoshi Imamura Hiroyuki Ikeda Kanta Tanaka Kanta Tanaka Hideyuki Ishihara Hiroto Kakita Takanori Sano Takanori Sano Hayato Araki Tatsufumi Nomura Fumihiro Sakakibara Shinichi Yoshimura for RESCUE AT-LVO Investigators Association of perioperative P2Y12 inhibitor administration with outcomes for tandem occlusion: RESCUE AT-LVO sub-study Frontiers in Neurology stroke tandem occlusion P2Y12 inhibitor endovascular therapy carotid artery stenting |
| title | Association of perioperative P2Y12 inhibitor administration with outcomes for tandem occlusion: RESCUE AT-LVO sub-study |
| title_full | Association of perioperative P2Y12 inhibitor administration with outcomes for tandem occlusion: RESCUE AT-LVO sub-study |
| title_fullStr | Association of perioperative P2Y12 inhibitor administration with outcomes for tandem occlusion: RESCUE AT-LVO sub-study |
| title_full_unstemmed | Association of perioperative P2Y12 inhibitor administration with outcomes for tandem occlusion: RESCUE AT-LVO sub-study |
| title_short | Association of perioperative P2Y12 inhibitor administration with outcomes for tandem occlusion: RESCUE AT-LVO sub-study |
| title_sort | association of perioperative p2y12 inhibitor administration with outcomes for tandem occlusion rescue at lvo sub study |
| topic | stroke tandem occlusion P2Y12 inhibitor endovascular therapy carotid artery stenting |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2024.1475882/full |
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