Emergency endovascular treatment of stroke due to cervical artery dissection - impact of periprocedural GP IIb/IIIa inhibitor use on clinical outcome.

Abstract

Background: Endovascular therapy (EVT) for large intracranial vessel occlusion or symptomatic hypoperfusion due to cervical artery dissection (CeAD) became the standard therapy in recent years. Stenting is frequently required to secure the dissection with subsequent need for GP IIb/IIIa inhibitors. However, a potential concern of antithrombotic therapy in acute stroke is the increased risk of intracerebral hemorrhage. The aim of the study was to assess the impact of the administration of a GP IIb/IIIa inhibitor imaging during endovascular treatment for acute ischemic stroke caused by CeAD on 90-day clinical outcome and intracranial hemorrhage.

Methods: This single-center retrospective cohort study enrolled CeAD patients with internal carotid artery (ICA) dissections treated with EVT from January 2015 to August 2022. We analysed the impact of different variables including postinterventional hemorrhage, revascularization success and the use of GP IIb/IIIa Inhibitors (eptifibatide) on 90-day favorable clinical outcome (mRS 0-2). NIHSS Scores were evaluated at different time points in relation to the 90-day clinical outcomes.

Results: Forty-nine patients were included in the study. Thrombectomy was performed in all patients. In 33 patients, stenting was performed in addition to thrombectomy. 20 patients (40.8%) received eptifibatide periinterventionally. 31 out of 49 patients (63.3%) had a favorable 90-day clinical outcome (mRS 0-2). Five patients showed radiologically significant hemorrhage. The rate of successful reperfusion (TICI 2b-3) in the favorable 90-day outcome group was significantly higher than in the unfavorable 90-day outcome group.

Conclusions: In this study, the use of a GP IIb/IIIa inhibitor use during EVT for stroke caused by CeAD did not affect 90-day clinical outcome nor the incidence of intracranial hemorrhage. Successful reperfusion significantly correlated with favorable clinical outcome.