Abstract DP026: Interaction of Periprocedural Antiplatelets and Intravenous Thrombolysis in Intracranial Stenting for Acute Ischemic Stroke: RESISTANT Registry Subanalysis

Introduction: Intracranial stenting during endovascular thrombectomy (EVT) is a common practice in the setting of failed reperfusion or severe stenosis. Immediate stent patency requires periprocedural antiplatelet therapy (APT). How APT intensity interacts with prior intravenous thrombolysis (IVT) to influence hemorrhagic risk remains uncertain. We aimed to assess whether the APT regimen modifies the association of IVT with early intracranial hemorrhage after intracranial stenting during EVT. Methods: This was a subanalysis of the RESISTANT registry, a multicenter, international, retrospective cohort (2016 to 2023) of adults with acute ischemic stroke who underwent intracranial stenting during EVT. APT regimens were categorized as conservative (intravenous or oral aspirin alone, or aspirin plus an oral P2Y12 inhibitor) and aggressive (any regimen including intravenous GPIIb/IIIa inhibitor or intravenous cangrelor). Four main groups were compared according to the APT regimen (conservative/aggressive) and the use of IVT (+/-). The primary outcome was a composite of sICH and parenchymal hematoma types 1 and 2 (sICH-PH2-PH1). Multivariable logistic regression models were used to evaluate the interaction between IVT and APT, adjusting for clinically relevant covariates. Results: Among the 823 included patients, 44 (5.3%) received conservative APT with IVT, 130 (15.8%) received conservative APT without IVT, 145 (17.6%) received aggressive APT with IVT, and 504 (61.2%) received aggressive APT without IVT. Among patients who received IVT, sICH-PH2-PH1 rates were 9.3% with conservative APT and 10.7% with aggressive APT; among those without IVT, rates were 3.2% and 9.9%, respectively. Administration of IVT (adjusted odds ratio [aOR] 5.84, 95%CI 1.07 to 43.92; p=0.05) and aggressive APT (aOR 4.81, 95% CI 1.41 to 30.22; p=0.03) were each associated with higher odds of hemorrhagic complications, with a significant IVT by APT interaction (P interaction =0.05; Figures 1 and 2 ). Within the aggressive APT plus IVT subgroup, sICH-PH2-PH1 occurred in 20% of patients treated with cangrelor and 6.1% treated with a glycoprotein IIb/IIIa inhibitor ( Figure 3 ). Conclusion: Among patients requiring intracranial stenting, aggressive periprocedural APT and prior IVT are each associated with higher hemorrhagic risk, with the combination showing the worst observed crude outcome. Prospective evaluation of protocolized APT pathways in the IVT setting is warranted.

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Journal
Stroke
Published
2026-01-29
DOI
https://doi.org/10.1161/str.57.suppl_1.dp026
Primary Topic
Acute Ischemic Stroke Management
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article

Abstract DP026: Interaction of Periprocedural Antiplatelets and Intravenous Thrombolysis in Intracranial Stenting for Acute Ischemic Stroke: RESISTANT Registry Subanalysis

J. Zamorro Parra, N. Abdelhakim, Nikolaos Ntoulias, Aaron Rodriguez Calienes et al.
Stroke
Acute Ischemic Stroke Management
article

Abstract DP026: Interaction of Periprocedural Antiplatelets and Intravenous Thrombolysis in Intracranial Stenting for Acute Ischemic Stroke: RESISTANT Registry Subanalysis

J. Zamorro Parra, N. Abdelhakim, Nikolaos Ntoulias, Aaron Rodriguez Calienes, Stefano Molinaro, Manuel Requena, Eric Kontowicz, Jérémy Hofmeister, D Yavagal, Fábio Gomes, M Piano, A Tomasello, S Ortega-Gutierrez, Isabel Fragata, Mohammad AlMajali, José Rodríguez Castro, Mauro Bergui, Luca Scarcia, Ameer E Hassan, Sadiq Al Salman, Adnan Mujanovic, Leonardo Cruz-Criollo, João André Sousa, Francesco Diana, Alfonso López-Frías, David Seoane, Michele Romoli, Jose Amorim, Asier de Albóniga-Chindurza, Amedeo Cervo, Eduardo Barcena, Pedro Vega, Songul Senadim, Pedro Navia, Manuel Moreu, Mariano Velo, Francesco Capasso, Joao Pedro Marto, Jorge Cespedes Segura, Tudor G. Jovin, Anderson Brito, Mohamad AbdalKader, Juan Arenillas, Paolo Machi, Marta Gadea, Pedro Castro, Adnan Siddiqui, Daniele G. Romano, Andrea M. Alexandre, Leonardo Renieri, Shadi Yaghi, Francesco Biraschi, Samantha Miller, Atilla Ozcan Ozdemir, Alessandro Pedicelli, Marc Ribo, serdar geyik, Johannes Kaesmacher, Thanh N. Nguyen, Elena Zapata-Arriaza
article en

Abstract

Introduction: Intracranial stenting during endovascular thrombectomy (EVT) is a common practice in the setting of failed reperfusion or severe stenosis. Immediate stent patency requires periprocedural antiplatelet therapy (APT). How APT intensity interacts with prior intravenous thrombolysis (IVT) to influence hemorrhagic risk remains uncertain. We aimed to assess whether the APT regimen modifies the association of IVT with early intracranial hemorrhage after intracranial stenting during EVT. Methods: This was a subanalysis of the RESISTANT registry, a multicenter, international, retrospective cohort (2016 to 2023) of adults with acute ischemic stroke who underwent intracranial stenting during EVT. APT regimens were categorized as conservative (intravenous or oral aspirin alone, or aspirin plus an oral P2Y12 inhibitor) and aggressive (any regimen including intravenous GPIIb/IIIa inhibitor or intravenous cangrelor). Four main groups were compared according to the APT regimen (conservative/aggressive) and the use of IVT (+/-). The primary outcome was a composite of sICH and parenchymal hematoma types 1 and 2 (sICH-PH2-PH1). Multivariable logistic regression models were used to evaluate the interaction between IVT and APT, adjusting for clinically relevant covariates. Results: Among the 823 included patients, 44 (5.3%) received conservative APT with IVT, 130 (15.8%) received conservative APT without IVT, 145 (17.6%) received aggressive APT with IVT, and 504 (61.2%) received aggressive APT without IVT. Among patients who received IVT, sICH-PH2-PH1 rates were 9.3% with conservative APT and 10.7% with aggressive APT; among those without IVT, rates were 3.2% and 9.9%, respectively. Administration of IVT (adjusted odds ratio [aOR] 5.84, 95%CI 1.07 to 43.92; p=0.05) and aggressive APT (aOR 4.81, 95% CI 1.41 to 30.22; p=0.03) were each associated with higher odds of hemorrhagic complications, with a significant IVT by APT interaction (P interaction =0.05; Figures 1 and 2 ). Within the aggressive APT plus IVT subgroup, sICH-PH2-PH1 occurred in 20% of patients treated with cangrelor and 6.1% treated with a glycoprotein IIb/IIIa inhibitor ( Figure 3 ). Conclusion: Among patients requiring intracranial stenting, aggressive periprocedural APT and prior IVT are each associated with higher hemorrhagic risk, with the combination showing the worst observed crude outcome. Prospective evaluation of protocolized APT pathways in the IVT setting is warranted.

StrokeVol. 57(Suppl_1)
University of Messina (IT), Boston Medical Center (US), University of Miami (US), Istanbul Aydın University (TR), Williams (United States) (US), Policlinico Umberto I (IT), Hospital Universitario La Paz (ES), University Hospital of Bern (CH), Hospitais da Universidade de Coimbra (PT), The University of Texas Rio Grande Valley (US), University Hospital of Basel (CH), Agostino Gemelli University Polyclinic (IT), Hospital Clínico San Carlos (ES), Hospital de São João (PT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), 5T Torino (Italy) (IT), Fondazione Ricerca Molinette (IT), Hospital Universitario 12 De Octubre (ES), University Hospital of Geneva (CH), Hospital de Egas Moniz (PT), Ospedale “M. Bufalini” di Cesena (IT), Azienda Ospedaliero-Universitaria Careggi (IT), Fondation de Rothschild (FR), Vall d'Hebron Hospital Universitari (ES), Bon Secours Mercy Health (US), Hôpitaux Universitaires Henri-Mondor (FR), Valley Baptist Medical Center (US), Hospital Universitario Central de Asturias (ES), Ospedali Riuniti San Giovanni di Dio e Ruggi d'Aragona (IT), Hospital Braga (PT), University of Iowa Health Care (US), Hackensack Meridian Health (US), Hospital Valle del Nalón (ES), Hospital Universitario Virgen de la Arrixaca (ES), Hospital Universitario Virgen del Rocío (ES), Hospital Clínico Universitario de Valladolid (ES), Florida Cancer Care (US), Eskişehir Osmangazi University (TR), University of Turin (IT), University at Buffalo, State University of New York (US)
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Acute Ischemic Stroke Management
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