Turkish Neurosurgery
Effect of antiplatelet preparation before endovascular thrombectomy for cerebral infarction on procedural thromboembolisms
Nam Taek Min1, Jang Ji Hwan1, Kim Young Zoon 1, Kim Kyu Hong1, Kim Seung Hwan1
1Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Department of Neurosurgery, Changwon,
DOI: 10.5137/1019-5149.JTN.33088-20.4

Aim:When intravenous thrombolysis cannot be performed for cerebral infarction, antiplatelet drugs can be used before endovascular thrombectomy (EVT) to prevent procedural thromboembolism. We retrospectively compared an antiplatelet-preparation group with a no-preparation group to evaluate the effect of the antiplatelet preparation on procedural thromboembolism during EVT with diffusion-weighted imaging (DWI).Material and Methods:From January 2017 to April 2020, EVT was performed in 60 patients with cerebral infarction. Patients were categorized into the antiplatelet-preparation group (n = 25) or the no-preparation group (n = 35). Procedural thromboembolism was defined as new DWI-positive lesions in other areas of the occluded artery after EVT.Results:The antiplatelet-preparation and no-preparation groups did not differ in the rate of procedural thromboembolism occurrence (6/25 [24.0%] vs. 6/35 [17.1%]; P = 0.532). Procedural thromboembolism was associated with age (74.4 ± 6.95 years vs. 65.7 ± 12.9 years; P = 0.028), atherosclerotic occlusion (66.7% vs. 29.2%; P = 0.022), and procedural time (97.4 ± 45.7 min vs. 60.1 ± 28.8 min; P = 0.001). Multivariable logistic regression analysis showed that factors affecting procedural thromboembolism during EVT for cerebral infarction were old age (odds ratio [OR], 1.133; 95% confidence interval [CI], 1.009-1.273; P = 0.035), atherosclerotic occlusion (OR, 7.434; 95% CI, 1.272-43.431; P = 0.026), and longer procedural time (OR, 1.023; 95% CI, 1.001 - 1.046; P = 0.006).Conclusion:The antiplatelet preparation had no significant protective effect on procedural thromboembolism during EVT for cerebral infarction. Old age, atherosclerotic occlusion, and longer procedural time were independent risk factors for procedural thromboembolism during EVT for cerebral infarction.

Corresponding author : Kim Seung Hwan