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Xu D, Yang C, Cao W, Zhang X, Yang S, Shen X, Xu J, Yu H. Platelet glycoprotein IIb/IIIa antagonists in ischemic stroke patients without endovascular therapy: A meta-analysis. Pharmacotherapy 2024; 44:675-691. [PMID: 38949433 DOI: 10.1002/phar.2949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 07/02/2024]
Abstract
Platelet glycoprotein (GP) IIb/IIIa antagonists have been employed in selective patients after endovascular therapy (EVT) for acute ischemic stroke (AIS), yet application in patients without EVT is debated. This meta-analysis of randomized controlled studies on AIS patients without EVT assessed the effectiveness and safety of platelet GP IIb/IIIa antagonists compared with traditional antiplatelet or thrombolysis therapy. Articles were retrieved from databases, including PubMed, Web of Science, EMBASE, and Cochrane. The risk of bias and certainty level of evidence were assessed. Fifteen studies were included. GP IIb/IIIa antagonists increased the proportion of patients with modified Rankin Scale (mRS) 0-1 (odd ratio [OR] 1.37, 95% confidence interval [CI] 1.04-1.81, p = 0.03), mRS 0-2 (OR 1.27, 95% CI 1.12-1.46, p = 0.0004), and Barthel Index (BI) 95-100 (OR 1.25, p = 0.005); decreased the proportion of stroke progression within 5 days (OR 0.66, p = 0.006); and lowered the mean mRS score at 90 days (mean difference [MD] -0.43, p = 0.002) and the National Institute of Health stroke scale score at 7 days (MD -1.64, p < 0.00001) compared with conventional treatment. Proportions of stroke recurrence within 90 days (OR 1.20, p = 0.60), any intracranial hemorrhage (aICH) (OR 1.20, p = 0.12), symptomatic intracranial hemorrhage (sICH) (OR 0.91, p = 0.88), and death (OR 0.87, p = 0.25) had no statistical difference between both groups. This meta-analysis finds that compared with traditional antiplatelet or thrombolysis therapy, GP IIb/IIIa antagonists administered within 24-96 h of ischemic stroke onset significantly improve functional prognosis of patients with AIS not receiving EVT, as indicated by mRS and BI at 90 days, and do not increase the incidence of aICH, sICH, and death.
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Affiliation(s)
- Dongjun Xu
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| | - Cheng Yang
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| | - Wei Cao
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| | - Xinyu Zhang
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| | - Shucong Yang
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| | - Xuning Shen
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| | - Jun Xu
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| | - Huijie Yu
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
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Delvoye F, Di Meglio L, Consoli A, Nomenjanahary MS, Dupont S, Labreuche J, Maier B, Piotin M, Blanc R, Escalard S, Boursin P, Hamdani M, Redjem H, Smajda S, Hébert S, Sabben C, de Noordhout AM, Jandrot-Perrus M, Lapergue B, Mazighi M, Ho-Tin-Noé B, Desilles JP. High thrombus platelet content is associated with a lower rate of first pass effect in stroke treated by endovascular therapy. Eur Stroke J 2022; 7:376-383. [PMID: 36478752 PMCID: PMC9720861 DOI: 10.1177/23969873221108740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/02/2022] [Indexed: 09/02/2024] Open
Abstract
BACKGROUND AND PURPOSE First pass effect (FPE), the occurrence of complete reperfusion after one pass with no rescue attempt during endovascular therapy (EVT), is associated with the best clinical outcome after an acute ischemic stroke (AIS). Previous studies evaluating FPE occurrence according to EVT technical strategies, occlusion locations, or thrombus composition have provided controversial results. Here, we performed a correlation analysis between FPE occurrence and AIS thrombus cellular composition, as assessed using quantitative biochemical assays. PATIENTS AND METHODS Homogenates of AIS thrombi from 250 patients were prepared by mechanical grinding. Platelet, red blood cell (RBC), and leukocyte contents of AIS thrombi were respectively estimated by quantification of GP (glycoprotein) VI, heme, and DNA in thrombus homogenates. FPE was defined as a modified Thrombolysis in Cerebral Infraction (mTICI) score of 2C or 3 after a single EVT device pass. RESULTS AIS thrombi successfully removed after a single pass were poorer in GPVI (0.098 ± 0.023 vs 0.111 ± 0.024 ng/mg, p < 0.001) compared to those whose removal had required several passes. GPVI content was also significantly associated with a higher number of device passes and a longer procedure time. No such significant correlation was found with DNA and heme content. DISCUSSION AND CONCLUSION Thrombus platelet content may hamper thrombus removal by EVT. This result suggests that adjunctive therapies or functionalization of retrieval devices targeting platelets may improve EVT efficacy.
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Affiliation(s)
- François Delvoye
- Interventional Neuroradiology
Department and Biological Resources Center, Rothschild Foundation Hospital, Paris,
France
- University of Liege, Liège,
Belgium
| | - Lucas Di Meglio
- Interventional Neuroradiology
Department and Biological Resources Center, Rothschild Foundation Hospital, Paris,
France
- Laboratory of Vascular Translational
Science, U1148 INSERM, Université de Paris, Paris, France
| | - Arturo Consoli
- Interventional Neuroradiology
Department, Hopital Foch, Suresnes, France
| | | | - Sébastien Dupont
- Laboratory of Vascular Translational
Science, U1148 INSERM, Université de Paris, Paris, France
| | | | - Benjamin Maier
- Interventional Neuroradiology
Department and Biological Resources Center, Rothschild Foundation Hospital, Paris,
France
- Laboratory of Vascular Translational
Science, U1148 INSERM, Université de Paris, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology
Department and Biological Resources Center, Rothschild Foundation Hospital, Paris,
France
- Laboratory of Vascular Translational
Science, U1148 INSERM, Université de Paris, Paris, France
| | - Raphael Blanc
- Interventional Neuroradiology
Department and Biological Resources Center, Rothschild Foundation Hospital, Paris,
France
- Laboratory of Vascular Translational
Science, U1148 INSERM, Université de Paris, Paris, France
| | - Simon Escalard
- Interventional Neuroradiology
Department and Biological Resources Center, Rothschild Foundation Hospital, Paris,
France
| | - Perrine Boursin
- Interventional Neuroradiology
Department and Biological Resources Center, Rothschild Foundation Hospital, Paris,
France
| | - Mylène Hamdani
- Interventional Neuroradiology
Department and Biological Resources Center, Rothschild Foundation Hospital, Paris,
France
| | - Hocine Redjem
- Interventional Neuroradiology
Department and Biological Resources Center, Rothschild Foundation Hospital, Paris,
France
| | - Stanislas Smajda
- Interventional Neuroradiology
Department and Biological Resources Center, Rothschild Foundation Hospital, Paris,
France
| | - Solène Hébert
- Interventional Neuroradiology
Department and Biological Resources Center, Rothschild Foundation Hospital, Paris,
France
| | - Candice Sabben
- Department of Neurology, Rothschild
Foundation Hospital, Paris, France
| | | | - Martine Jandrot-Perrus
- Laboratory of Vascular Translational
Science, U1148 INSERM, Université de Paris, Paris, France
| | | | - Mikael Mazighi
- Interventional Neuroradiology
Department and Biological Resources Center, Rothschild Foundation Hospital, Paris,
France
- Laboratory of Vascular Translational
Science, U1148 INSERM, Université de Paris, Paris, France
- Université de Paris, Paris,
France
- FHU Neurovasc, Department of Neurology,
Hopital Lariboisère, APHP Nord, Paris, France
| | - Benoit Ho-Tin-Noé
- Laboratory of Vascular Translational
Science, U1148 INSERM, Université de Paris, Paris, France
| | - Jean-Philippe Desilles
- Interventional Neuroradiology
Department and Biological Resources Center, Rothschild Foundation Hospital, Paris,
France
- Laboratory of Vascular Translational
Science, U1148 INSERM, Université de Paris, Paris, France
- Université de Paris, Paris,
France
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Larco J, Abbasi M, Liu Y, Dai D, Lanzino G, Savastano L, Cloft H, Kallmes D, Kadirvel R, Brinjikji W. Postprocedural Thrombosis following Endovascular Treatment of Intracranial Aneurysm with Flow Diverters or Coiling: A Histologic Study. AJNR Am J Neuroradiol 2022; 43:258-264. [PMID: 34916206 PMCID: PMC8985686 DOI: 10.3174/ajnr.a7369] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023]
Abstract
Endovascular treatment of aneurysms with flow diverters or coiling is sometimes complicated by intraprocedural or postprocedural thrombosis along or within the devices. Thrombus composition and structure associated with such complications may provide insights into mechanisms of thrombus formation and clinical strategies to remove the thrombus. We present a retrospective histopathologic study of 4 patients who underwent mechanical thrombectomy due to acute occlusion of either implanted flow diverter devices or along coils during the treatment of intracranial aneurysm.
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Affiliation(s)
- J.A. Larco
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - M. Abbasi
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - Y. Liu
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - D. Dai
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
| | - G. Lanzino
- Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - L.E. Savastano
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - H. Cloft
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
| | - D.F. Kallmes
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
| | - R. Kadirvel
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.)
| | - W. Brinjikji
- From the Departments of Radiology (J.A.L., M.A., Y.L.,
D.D., L.E.S., H.C., D.F.K., R.K., W.B.),Neurosurgery (J.A.L., M.A., Y.L., G.L., L.E.S., D.F.K.,
W.B.), Mayo Clinic, Rochester, Minnesota
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