Mono antiplatelet therapy for cardioembolic and undetermined etiological stroke after receiving successful mechanical thrombectomy
Section snippets
Background
Cardioembolic (CE) stroke account for 14%–30% of all ischemic strokes, which often indicate high loaded thrombus, large vessel occlusion and poor response to intravenous thrombosis, thus requires immediate intervention. Cardioembolic stroke is characterized by embolus occlusion and a non-arteriosclerotic cerebral arterial wall thus complete recanalization and good blood flow restoration can be achieved once the thrombus was removed. Re-occlusion is less while hemorrhagic transformation may more
Patients
The ethics committee of Shanghai Jiaotong university affiliated sixth people`s hospital approved this study. Consecutive patients with acute ischemic stroke who were referred for endovascular treatment in our hospital between March 2016 and December 2018 was retrospectively reviewed. The inclusion criteria include: i) Patients was confirmed anterior circulation stroke; ii) non-enhanced brain CT scan excluded sICH for patients received IV-rtPA bridged MT therapy at 24 h or received directly MT
Patient characteristics
A total of 191 consecutive stroke patients received MT treatment in our center, and 178 patients received MT in the anterior circulation were retrospectively enrolled into analyzed in present study. Fifty-three patients were excluded before MA therapy from this study, include i) 32 patients with stroke caused by large-artery atherosclerosis or other etiology such as arterial dissections; ii) 2 patients confirmed immediate sICH; iii) 17 patients recanalization with poor flow reperfusion (mTICI
Discussion
In this study, mono antiplatelet therapy strategy was used for the treatment of a group of ACS patients caused by cardioembolic and undetermined etiological stroke who underwent successful good flow restoration. Our main findings revealed that: i) mono antiplatelet therapy can effectively maintain the target artery patency; ii) mono antiplatelet therapy did not resulting in higher risk of sICH in the acute stage; iii) mono antiplatelet therapy presented similar treatment outcomes between the
Conclusions
Mono antiplatelet therapy is safe and effective for maintaining flow patency in ACS patients who received stent thrombectomy recanalization in the acute stage before the initiation of anticoagulation therapy. However, further randomized controlled trials are needed to provide more reliable evidence for the antithrombotic strategy for ACS patients who received endovascular MT.
Ethics approval and consent to participate
The ethics committee of Shanghai Jiaotong university affiliated sixth people`s hospital approved this study.
Funding
This work was supported by Dr. Z.Y.Q:
i) Cross medical research fund of translational medicine by Shanghai Jiao Tong University (ZH2018ZDA19);
ii) Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support (No. 20152528);
Availability of data and material
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Authors' contributions
1. D.J. and H.G.: Acquisition of data, analysis and interpretation of data and drafting of the manuscript
2. Z.Y. and Z.Y.: Study concept and design, critical revision of the manuscript for important intellectual content and study supervision
3. L.H., L.Y. and W.L.: acquisition of data and statistical analysis.
4. L.M.: critical revision of the manuscript for important intellectual content
All authors consent for publication of this study
Declaration of Competing Interest
We declare there in no competing interests in this study.
Acknowledgements
None.
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Guangchen He and Jiangshan Deng contribute equally to this study.