380 Oral Aspirin Plus Ticagrelor Versus Intravenous Eptifibatide Load Prior to Emergent Carotid Artery Stenting for Mechanical Thrombectomy in Anterior Circulation Tandem Strokes

INTRODUCTION: The utility of emergent carotid artery stenting (eCAS) during mechanical thrombectomy (MT) for tandem occlusions has been well-described. Single antiplatelet therapy after eCAS in tandem occlusions prevents the risk of reperfusion hemorrhage, though the risk of in-stent occlusion remains, and the optimal antiplatelet strategy remains unexplored. METHODS: Retrospective cohort study analyzing an institutional MT database. Patients were dichotomized into those receiving oral aspirin/ticagrelor load (DAPT cohort) versus intravenous eptifibatide load (Integrilin cohort) prior to eCAS during MT for tandem occlusions. Patient demographics, thrombectomy details, in-hospital course, and follow-up outcomes were compared. RESULTS: We included 138 patients with anterior circulation tandem strokes and baseline mRS 0-2. There were no differences in baseline demographics. The Integrilin cohort had more patients undergoing MT via radial access (30.4%-vs-8.7%, p=0.009) and more patients undergoing retrograde eCAS (34.8%-vs-13%, p=0.027). No differences in first pass (TICI2C-3) or modified first pass (TICI2b-3) effect rate were observed between the cohorts, through anterograde or retrograde approaches, after all passes (2.22±1.38-vs-1.58±0.95, p=0.008). Both had comparable procedural and fluoroscopy duration (p>0.05). No difference in intraprocedural stent occlusion was observed. Patients in the DAPT cohort had lower rates of post-procedure stent occlusion up to day 7 compared to those in the Integrilin cohort (5.2%-vs-30.4%, OR:0.126[0.038-0.422], p<0.001). No difference in symptomatic or asymptomatic hemorrhage rates were observed-post procedure. There were no differences in mRS 0-1, 0-2 or 0-3 at day 7, discharge, or 90 days between the treatment groups. CONCLUSIONS: Our study demonstrates that loading with aspirin/ticagrelor significantly reduces the rate of post-procedural in-stent occlusion in the short term. These results can inform practice patterns for these difficult conditions and hope to validate the findings in a multi-institution series.