Table 3.
Characteristics of included studies investigating patients with ischemic stroke caused by a “tandem lesions” who underwent acute MT with or without emergency extracranial carotid stenting, who received periprocedural antithrombotic drugs as protocol-based care.
| Study characteristics | Population characteristics | Treatment characteristics | Study treatment | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reference | Study design | N | Age | NIHSS at baseline | Occlusion location | IV tPA, n/N (%) | IA tPA, n/N (%) | MT, n/N (%) | Stenting, n/N (%) | Time from symptom onset to recanalization therapy (min) | Antithrombotic treatment when stent deployment was performed | Time from symptom onset to antithrombotic treatmenta |
| Behme et al. (21) | Retrospective cohort | 170 | Median: 64 | Median: 15 | Anterior circulation | 122/170 (72%) | 0/170 (0%) | 170/170 (100%) | 170/170 (100%) | Median: 98 |
Periprocedural: Center A, loading dose of eptifibatide 180 μg/kg; Center B, loading dose of ASA 500 mg and clopidogrel 375 mg; Center C, loading dose of tirofiban (weight-adapted); Center D, loading dose of ASA 500 mg IV, plus 5,000 IU UFH or tirofiban Postprocedural: Center A, continuous infusion eptifibatide for the first 24 h, hereafter dual antiplatelet treatment (loading clopidogrel 300 mg and ASA 500 mg); Center B, continuation clopidogrel 75 mg/d and ASA 100mg/d for 3 months; Center C, continuous infusion of tirofiban for the first 24 h, hereafter loading 500 mg ASA and 300 mg clopidogrel, continuation with 75 mg/d clopidogrel and 100 m/d for 3 months; Center D, loading dose of clopidogrel 500 mg, hereafter ASA 100 mg/d and clopidogrel 75 mg/d for 3 months |
Acute |
| Cohen et al. (23) | Retrospective cohort | 24 | Mean: 66 | Median: 18 (14–28) | Anterior circulation | 10/24 (42%) | 0/24 (0%) | 24/24 (100%) | 24/24 (100%) | Mean: 198 |
Periprocedural: Loading dose of 2,500 IU UFH (after femoral access, and confirmation for the need of stent implantation), patients not on antiplatelet therapy received a loading dose of 300 mg ASA Postprocedural: Loading dose of clopidogrel 300 mg added to ASA use. Two months dual therapy (clopidogrel 75 mg/d plus ASA 100 mg/d) |
Acute |
| Heck and Brown (25) | Retrospective cohort | 23 | Mean: 70 | Median: 17 (9–25) | Anterior circulation | 7/23: (30%) | 0/23 (0%) | 23/23 (100%) | 23/23 (100%) | NR |
Periprocedural: Loading dose of ASA 300 mg in all patients, 12 patients loading dose of abciximab 0.25 mg/kg Postprocedural: Loading dose of clopidogrel 600 mg if no abciximab was administered |
NR |
| Lockau et al. (28) | Retrospective cohort | 37 | Mean: 63 | Median: 17 (3–30) | Anterior circulation | 20/37: (54%) | 0/37 (0%) | 37/37 (100%) | 37/37 (100%) | NR |
Periprocedural: Loading dose of tirofiban (weight adapted) Postprocedural: Continuous infusion of tirofiban for the first 24 h, after exclusion of hemorrhage loading dose of ASA 500 mg and clopidogrel 300 mg. Hereafter, ASA 100 mg/d and clopidogrel 75 mg/d for 3 months |
Acute |
| Maurer et al. (30) | Retrospective cohort | 43b | Mean: 68 (±13) | Mean: 13 (±5) | Anterior circulation | 33/43 (77%) | 20/43 (47%) | 27/43 (63%) | 39/43 (91%) | NR |
Periprocedural: Loading dose of ASA (500 mg) and IV UFH bolus (5,000 IU) before stent placement Postprocedural: Loading dose of clopidogrel 600 mg or ticagrelor 180 mg |
NR |
| Marnat et al. (29) | Retrospective cohort | 20 | Mean: 53 | Mean: 18 | Anterior circulation | 15/20 (75%) | 0/20 (0%) | 20/20 (100%) | 5/20 (25%) | Mean: 263 |
Periprocedural: Loading dose of ASA 500 mg Postprocedural: Local protocol |
Acute + early |
| Rangel-Castilla et al. (34) | Retrospective cohort | 45 | Mean: 64 | Mean: 14 | Anterior circulation | 15/45 (33%) | 0/45 (0%) | 45/45 (100%) | 45/45 (100%) | Mean: 139 |
Periprocedural: Loading dose of ASA 650 mg and clopidogrel 600 mg or ticagrelor 180 mg. After confirmation of cervical occlusion heparinization at an activated coagulation time of ≥250 s Postprocedural: Local protocol at 24 h |
Acute |
| Stampfl et al. (35) | Retrospective cohort | 24 | Mean: 67 (±10) | Median: 18 (15–22) | Anterior circulation | 22/24 (92%) | 0/24 (0%) | 24/24 (100%) | 24/24 (100%) | Mean: 230 (±131) |
Periprocedural: 17 patients continuous infusion of tirofiban; 5 patients loading dose of ASA and clopidogrel and UFH; 2 patients (on prior antiplatelet) loading dose of UFH Postprocedural: Patients on tirofiban continuation for the first 24–48 h; all patients 100 mg/d ASA and clopidogrel 75 mg/d |
Acute + early |
Characteristics of the included studies are presented by sample size (percentage), mean (SD), median (interquartile ranges), or by remarks.
ASA, acetylsalicylic acid; IA, intraarterial; IV, intravenous; MT, mechanical thrombectomy (by means of stent retriever or aspiration); NR, not reported; tPA, tissue plasminogen activator; UFH, unfractionated heparin.
aTime from symptom onset to antithrombotic treatment was divided into acute administration (<6 h) and early administration (6–24 h).
bNot solely MT.