Introduction: Recent clinical trials have established the efficacy of mechanical thrombectomy (MT) for the treatment of acute ischemic stroke (AIS) in patients with large vessel anterior circulation occlusion. There is limited data on outcomes and hemorrhagic transformation (HT) risk in patients that also underwent carotid stenting (approximately 10%) during MT which requires immediate antiplatelet use.
Methods: We queried the Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS) (from 2006 to 2010) with ICD 9 diagnostic codes for AIS published by HCUP. ICD-9 99.1 was used for intravenous r-tPA and ICD-9 procedure code 39.71 (MT), 00.61 and 00.63 (for Carotid Stenting). This identified AIS patients who received MT w/wo carotid stenting. Primary outcomes were in-hospital mortality, HT (ICD9 430, 431, 432.0-432.9), and significant disability at discharge (to intermediate and long term skilled nursing facility). In addition to demographics, co-morbid vascular risk factors, use of anticoagulation/antiplatelet and in-hospital complications including DVT, PE, sepsis, and hospital acquired infections were controlled as confounders.
Results: 10,475 (weighted N) patients received MT out of which 1175 (11.22%) patients also underwent carotid stenting. After controlling for age, sex, race, Atrial fib, diseases of endocardium, alcohol, tobacco use, diabetes mellitus, hypertension, long-term (current) use of antiplatelet, long-term (current) use of anticoagulation, carotid artery stenosis, hospital acquired infection, sepsis, DVT, PE, year and hyperlipidemia we found that patients receiving carotid stenting had no significant differences in mortality OR 1.02 (95% CI 0.687-1.518; p=0.9178), HT OR 1.183 (95% CI 0.678-2.066; p=0.5535), disability at discharge OR 0.817 (95% CI 0.562-1.189; p=0.2915) compared to controls. Diabetes was an independent predictor of mortality OR 1.375 (95% CI 1.007-1.877) and disability OR 1.446 (95% CI 1.057-1.978).
Conclusion: Prevention of stent thrombosis with early antiplatelet use does not appear to increase the risk of HT in endovascularly treated AIS patients receiving carotid stenting. There was no significant increased risk of HT, mortality and morbidity in this subgroup.