Antithrombotic regimen in emergent carotid stenting for acute ischemic stroke due to tandem occlusion: a meta-analysis of aggregate data.

Diana, Francesco; Abdalkader, Mohamad; Behme, Daniel; Li, Wei; Maurer, Christoph Johannes; Pop, Raoul; Hwang, Yang-Ha; Bartolini, Bruno; Da Ros, Valerio; Bracco, Sandra; Cirillo, Luigi; Marnat, Gaultier; Katsanos, Aristeidis H; Kaesmacher, Johannes; Fischer, Urs; Aguiar de Sousa, Diana; Peschillo, Simone; Zini, Andrea; Tomasello, Alejandro; Ribo, Marc; ... (2024). Antithrombotic regimen in emergent carotid stenting for acute ischemic stroke due to tandem occlusion: a meta-analysis of aggregate data. Journal of neurointerventional surgery, 16(3), pp. 243-247. BMJ Publishing Group 10.1136/jnis-2023-020204

[img] Text
s41415-023-5740-x.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (370kB) | Request a copy


The periprocedural antithrombotic regimen might affect the risk-benefit profile of emergent carotid artery stenting (eCAS) in patients with acute ischemic stroke (AIS) due to tandem lesions, especially after intravenous thrombolysis. We conducted a systematic review and meta-analysis to evaluate the safety and efficacy of antithrombotics following eCAS.


We followed PRISMA guidelines and searched MEDLINE, Embase, and Scopus from January 1, 2004 to November 30, 2022 for studies evaluating eCAS in tandem occlusion. The primary endpoint was 90-day good functional outcome. Secondary outcomes were symptomatic intracerebral hemorrhage, in-stent thrombosis, delayed stent thrombosis, and successful recanalization. Meta-analysis of proportions and meta-analysis of odds ratios were implemented.


34 studies with 1658 patients were included. We found that the use of no antiplatelets (noAPT), single antiplatelet (SAPT), dual antiplatelets (DAPT), or glycoprotein IIb/IIIa inhibitors (GPI) yielded similar rates of good functional outcomes, with a marginal benefit of GPI over SAPT (OR 1.88, 95% CI 1.05 to 3.35, Pheterogeneity=0.31). Sensitivity analysis and meta-regression excluded a significant impact of intravenous thrombolysis and Alberta Stroke Program Early CT Score (ASPECTS). We observed no increase in symptomatic intracerebral hemorrhage (sICH) with DAPT or GPI compared with noAPT or SAPT. We also found similar rates of delayed stent thrombosis across groups, with acute in-stent thrombosis showing marginal, non-significant benefits from GPI and DAPT over SAPT and noAPT.


In AIS due to tandem occlusion, the periprocedural antithrombotic regimen of eCAS seems to have a marginal effect on good functional outcome. Overall, high intensity antithrombotic therapy may provide a marginal benefit on good functional outcome and carotid stent patency without a significant increase in risk of sICH.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Kaesmacher, Johannes, Fischer, Urs Martin


600 Technology > 610 Medicine & health




BMJ Publishing Group




Pubmed Import

Date Deposited:

16 May 2023 14:59

Last Modified:

14 Feb 2024 00:11

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

stent stroke thrombectomy thrombolysis




Actions (login required)

Edit item Edit item
Provide Feedback