Spina, Emanuele (2023) Early loading dose of dual antiplatelet treatment in acute ischemic stroke associated with tandem lesion. [Tesi di dottorato]
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| Tipologia del documento: | Tesi di dottorato |
|---|---|
| Lingua: | English |
| Titolo: | Early loading dose of dual antiplatelet treatment in acute ischemic stroke associated with tandem lesion |
| Autori: | Autore Email Spina, Emanuele ema.spina@libero.it |
| Data: | 21 Dicembre 2023 |
| Numero di pagine: | 61 |
| Istituzione: | Università degli Studi di Napoli Federico II |
| Dipartimento: | Neuroscienze e Scienze Riproduttive ed Odontostomatologiche |
| Dottorato: | Neuroscienze |
| Ciclo di dottorato: | 36 |
| Coordinatore del Corso di dottorato: | nome email Taglialatela, Maurizio maurizio.taglialatela@unina.it |
| Tutor: | nome email Manganelli, Fiore [non definito] |
| Data: | 21 Dicembre 2023 |
| Numero di pagine: | 61 |
| Parole chiave: | Acute Ischemic Stroke; Tandem occlusion; Carotid artery stenting; Intravenous Thrombolysis; Dual antiplatelet therapy |
| Settori scientifico-disciplinari del MIUR: | Area 06 - Scienze mediche > MED/26 - Neurologia |
| Depositato il: | 19 Gen 2024 07:54 |
| Ultima modifica: | 13 Mar 2026 08:23 |
| URI: | http://www.fedoa.unina.it/id/eprint/15714 |
Abstract
Background and Purpose: Acute antiplatelet treatment in tandem lesions treated with intravenous thrombolysis (IVT), endovascular thrombectomy (EVT) and acute carotid stenting (CAS) is challenging as a careful balance between the risk for intracerebral hemorrhage (ICH) and stent thrombosis is needed. We aimed to investigate the effects of early (within 12 hours) loading dose of Aspirin and Clopidogrel (A+C) after IVT and EVT+CAS. Methods: A retrospective analysis from a single center was performed. The primary outcome was the occurrence of ICH, secondary outcomes included rates of parenchymal hematoma, stent thrombosis, death, and independence at 90 days. Results: The study included 78 patients all receiving IVT, EVT+CAS, and 500 mg Aspirin at stent placement. 7 patients did not receive any adjunctive Clopidogrel: 2 because of early stent thrombosis and 5 due to intracerebral hematoma. In the 71 patients receiving Clopidogrel, an early loading dose (300 mg within 12 hours from IVT) did not affect the rate of ICH (33.3% versus 52.1% [p>0.05]). The only significant predictor of ICH was the ASPECT score calculated on a CT scan obtained before Clopidogrel treatment (OR 0.57, 95% CI 0.40–0.83), and ASPECTS <8 identified patients at higher risk of ICH. The rate of stent occlusion was lower in patients treated with early A+C (0% vs 8.3%); other secondary outcomes did not differ. Conclusions: Administering a loading dose of A+C within 12 hours after IVT, EVT and CAS in tandem lesions resulted safe in terms of hemorrhagic transformation and effective in preventing stent thrombosis.
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