Abstract
Introduction/Purpose Large vessel occlusions with underlying ICAS (ICAS‐LVO) are challenging to treat and may require rescue stenting (RS). However, the ideal protocol of antiplatelet therapy (APT) after RS is unknown. We investigated the safety and efficacy of APT in patients that underwent RS due to ICAS‐LVO. Materials/Methods We conducted a sub‐analysis of the Registry of Emergent Large Vessel Occlusion due to Intracranial Stenosis (RESCUE‐ICAS), to investigate the efficacy and safety of APT in patients that required RS. The APT evaluated were glycoprotein IIb/IIIa inhibitors (GPI) and P2Y12 antagonists. GPI included eptifibatide and tirofiban, while P2Y12 inhibitors involved cangrelor. Primary efficacy outcomes were successful recanalization (detailed as a thrombolysis in cerebral ischemia [TICI] ≥ 2b at the end of the procedure). Secondary efficacy outcomes involved excellent recanalization (TICI ≥ 2c) and complete recanalization (TICI 3). Primary safety outcomes included symptomatic intracranial hemorrhage (sICH), and secondary safety outcomes involved vessel re‐occlusion, any ICH, in‐hospital mortality and recurrent stroke in 90 days. Results A total of 149 patients were included, 122/149 (81.9%) patients received GPI and 27/149 (18.1%) P2Y12 antagonists. Patients receiving GPI had higher number of passes compared to the ones in the P2Y12 cohort (median: 3 [IQR: 2‐4] vs median: 2 [IQR: 1‐4], p = 0.02). Likewise, patients that had GPI infusion tended to have better successful recanalization rates (TICI ≥ 2b, 94.3% vs 85.9%, p = 0.22), higher rates of excellent recanalization (TICI 2c, 48.4% vs 18.5%, p = 0.004) and complete recanalization (TICI 3, 27.9% vs 0.0%, p < 0.001) compared to their counterpart receiving P2Y12 antagonists. No difference was found in the rate of sICH (5.7% vs 3.7%, p = 1.00), re‐occlusion (12/68 [17.6%] vs 1/68 [1.47%], p = 1.00), intraprocedural complications rates (7.4% vs 11.1%, p = 0.46), any ICH (27.9% vs 18.5%, p = 0.47), in‐hospital mortality (18.2% vs 4.5%, p = 0.20) or recurrent stroke (9.0% vs 7.4%, p = 1.00) between both groups. Conclusions The use of APT in RS for ICAS‐LVO appears to be safe and effective. The administration of GPI might be superior to P2Y12 antagonists in achieving higher rates of successful recanalization.