Journal article
Impact of intraprocedural antiplatelet therapy on stent patency and safety after emergent intracranial stenting in acute ischaemic stroke: insights from the RESISTANT registry
European stroke journal, Vol.11(1), aakaf005
01/01/2026
DOI: 10.1093/esj/aakaf005
Abstract
Introduction Emergent intracranial stenting (EIS) is increasingly employed in the context of the acute ischaemic stroke treatment, but requires intraprocedural antiplatelet therapy (APT), which may raise haemorrhagic risk. This study aimed to evaluate the safety and effectiveness of different APT regimens during EIS. Patients and methods This is a subanalysis of the RESISTANT registry, which is a multicenter retrospective registry of patients with acute ischaemic stroke treated with intracranial EIS between 2016 and 2023. Patients receiving intraprocedural antithrombotics were included. Primary efficacy outcomes were stent patency (intraprocedural and within 24 hours) and 3-month mRS. Secondary outcome was successful reperfusion (modified thrombolysis in cerebral infarction >= 2b), and the safety outcome was sICH. Multivariable and propensity score-matched analyses were performed. Results Among 827 patients, 4 APT strategies were identified: single APT (n = 102), oral dual antiplatelet therapy (dAPT) (Aspirin + Clopidogrel or Ticagrelor; n = 83), Cangrelor (n = 92) and GP IIb/IIIa inhibitors (GPi) (n = 550). Intravenous agents (Cangrelor/GPi) showed a trend towards lower risk of intraprocedural stent occlusion compared to oral dAPT (adjusted odds ratio [aOR] 0.30, [95% CI, 0.09-1.01], P = .053), though this did not reach statistical significance. GP IIb/IIIa inhibitors continued to demonstrate a protective trend at 24 hours (aOR 0.25, [95% CI, 0.06-0.99], P = .047), without a significant increase in sICH. Both intravenous agents were independently associated with higher odds of successful final reperfusion (odds ratio [OR] 4.35, [95% CI, 1.57-12.09], P = .001). No significant differences emerged between GPi and Cangrelor in matched analysis. No significant difference was observed on good functional outcome between APT strategies. Conclusion In the setting of EIS, intravenous APT agents (Cangrelor or GPi) were associated with improved stent patency and higher rates of successful reperfusion, without a significant increase in symptomatic haemorrhage.
Details
- Title: Subtitle
- Impact of intraprocedural antiplatelet therapy on stent patency and safety after emergent intracranial stenting in acute ischaemic stroke: insights from the RESISTANT registry
- Creators
- Francesco Diana - Vall d'Hebron Institut de RecercaAmeer E. Hassan - Valley Baptist Medical CenterSantiago Ortega-Gutierrez - University of IowaSamantha Miller - Valley Baptist Medical CenterAaron Rodriguez-Calienes - University of IowaMarta Olive Gadea - Vall dHebron Univ Hosp, Stroke Unit, Barcelona, SpainJohannes Kaesmacher - University Hospital of BernAdnan Mujanovic - University Hospital of BernSerdar Geyik - Istanbul UniversitySongul Senadim - Istanbul UniversityMariangela Piano - Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaAmedeo Cervo - Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaAndrea Salcuni - Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaManuel Moreu - Hospital Clínico San CarlosAlfonso Lopez-Frias - Hospital Clínico San CarlosElena Zapata Arriaza - Virgen del Rocio Univ Hosp, Dept Radiol, Intervent Neuroradiol, Seville, SpainAsier De Alboniga-Chindurza - Hospital Universitario Virgen del RocíoMauro Bergui - Azienda Ospedaliera Citta' della Salute e della Scienza di TorinoStefano Molinaro - Azienda Ospedaliera Citta' della Salute e della Scienza di TorinoJoao Andre Sousa - University of CoimbraJoao Sargento-Freitas - University of CoimbraFabio Gomes - University of CoimbraAndrea Alexandre - Agostino Gemelli University PolyclinicAlessandro Pedicelli - Agostino Gemelli University PolyclinicPaolo Machi - Geneva CollegeJeremy Hofmeister - Geneva CollegeLuca Scarcia - Hôpitaux Universitaires Henri-MondorErwah Kalsoum - Hôpitaux Universitaires Henri-MondorJose Amorim - Hospital BragaTorcato Meira - Hospital BragaLeonardo Renieri - Azienda Ospedaliero-Universitaria CareggiFrancesco Capasso - Azienda Ospedaliero-Universitaria CareggiDaniele G. Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'AragonaEduardo Barcena - Hospital Universitario 12 De OctubreDavid Seoane - Hospital Universitario 12 De OctubreMohamad Abdalkader - Boston Medical CenterPiers Klein - Boston Medical CenterThanh N. Nguyen - Boston Medical CenterCatarina Perry - Unidade Local de Saúde de São JoséIsabel Fragata - Unidade Local de Saúde de São JoséDileep R. Yavagal - Jackson Memorial HospitalJude H. Charles - Jackson Memorial HospitalJose Rodriguez - Central University Hospital of AsturiasPedro Vega - Central University Hospital of AsturiasAtilla O. Ozdemir - Eskişehir Osmangazi UniversityZehra Uysal - Eskişehir Osmangazi UniversityStanislas Smajda - Fondation de RothschildSadiq Al Salman - Fondation de RothschildJane Khalife - Cooper University Health CareTudor Jovin - Cooper University HospitalFrancesco Biraschi - Policlinico Umberto IFrancesca Ricchetti - Policlinico Umberto IPedro Castro - Hospital de São JoãoLuis Albuquerque - Hospital de São JoãoAdnan H. Siddiqui - University at Buffalo, State University of New YorkVinay Jaikumar - University at Buffalo, State University of New YorkPedro Navia - Hospital La Paz Institute for Health ResearchNikolaos Ntoulias - University Hospital of BaselMarios Psychogios - University Hospital of BaselMariano Velo - University of MessinaJoaquin Zamarro - Hospital Universitario Virgen de la ArrixacaGonzalo De Paco - Hospital Universitario Virgen de la ArrixacaYazan Ashouri - Bon Secours Mercy HealthMohammad AlMajali - Bon Secours Mercy HealthJuan F. Arenillas - Hospital Clínico Universitario de ValladolidAlicia Sierra - Hospital Clínico Universitario de ValladolidMichele Romoli - Ospedale “M. Bufalini” di CesenaJoao Pedro Marto - Hospital de Egas MonizShadi Yaghi - Brown UniversitySimone Peschillo - Health & LifeMarc Ribo - Vall d'Hebron Hospital UniversitariAlejandro Tomasello - Vall d'Hebron Institut de RecercaManuel Requena - Vall d'Hebron Institut de Recerca
- Resource Type
- Journal article
- Publication Details
- European stroke journal, Vol.11(1), aakaf005
- DOI
- 10.1093/esj/aakaf005
- ISSN
- 2396-9873
- eISSN
- 2396-9881
- Publisher
- Oxford University Press
- Number of pages
- 10
- Language
- English
- Date published
- 01/01/2026
- Academic Unit
- Neurology; Radiology; Neurosurgery
- Record Identifier
- 9985121588402771
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