Mono antiplatelet therapy for cardioembolic and undetermined etiological stroke after receiving successful mechanical thrombectomy

• Published in: Clinical neurology and neurosurgery Vol. 201; p. 106412
• Main Authors: He, Guangchen, Deng, Jiangshan, Lu, Haitao, Wei, Liming, Li, Minghua, Zhao, Yuwu, Zhu, Yueqi
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2021; Elsevier Limited
• Subjects: Acute ischemic stroke; Antiplatelet treatment; Aspirin; Atherosclerosis; Blood clots; Blood platelets; Cardiac arrhythmia; Catheters; Clopidogrel; Etiology; Hemorrhage; Hospitals; Medical imaging; Neurology; Statistical analysis; Stents; Stroke; Thrombectomy; Veins & arteries; HI; SUE; CE; PACS; Antiplatelet treatment; MT; sICH; mRS; mTICI; CTA; Thrombectomy; MA; Acute ischemic stroke; PH; MRA
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2020.106412

•Mono antiplatelet therapy can effectively maintain the target artery patency.•Mono antiplatelet therapy did not result in higher risk of sICH in the acute stage.•Mono antiplatelet therapy presented similar treatment outcomes between the cardioembolic stroke and undetermined etiological stroke. Recent studies indicated that majority of stroke with undetermined etiology (SUE) showed strong overlap with cardioembolic stroke (CE). We intended to determine the efficacy of the mono antiplatelet (MA) therapy in both stroke types after receiving successful mechanical thrombectomy (MT) recanalization in the acute stage. 178 consecutive stroke patients who received MT treatment were retrospectively analyzed. For CE and SUE type stroke patients, aspirin 100 mg or clopidogrel 75 mg was added immediate for those didn`t received IV-rtPA and after 24 h for those received IV-rtPA if symptomatic intracranial hemorrhage (sICH) was not found. MA treatment outcomes included recanalized artery patency, subsequent sICH and functional independence (mRS score 0–2) were compared between two stroke types. 75 CE and 50 SUE patients were included into final analysis. Target artery was confirmed 100 % patency in the CE group and 97.5 % in the SUE group at 7 days after recanalization. Hemorrhagic transformation after 24 h was found in 10 % patients in the SUE group and in 12 % patients in the CE group (P > 0.05). sICH was confirmed in 1 patient in the SUE group and in 2 patients in the CE group. At 90 days, 45.8 % in the SUE group and 46.5 % in the CE group of patients had achieved good outcomes (P = 1.00). However, accumulative death was higher in the CE group than in the SUE group (21 % vs. 15 %; P = 0.47). For patients considered CE or SUE stroke types, mono antiplatelet therapy after good flow restoration by thrombectomy is safe and effective.