• Abdelaziz Amllay, Andrea Becerril-Gaitan, Adam Hunt, Paarth Jain, Ching-Jen Chen, Kareem El Naamani, Rawad Abbas, Levi Rudick, Stavropoula I Tjoumakaris, M Reid Gooch, Nabeel A Herial, Hekmat Zarzour, Richard F Schmidt, Robert H Rosenwasser, and Pascal M Jabbour.
• Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
• World Neurosurg. 2023 Aug 1; 176: e476e484e476-e484.

BackgroundMechanical thrombectomy (MT) is performed in patients who are already on anticoagulation (AC)/antiplatelet therapy (AP). However, data are insufficient regarding MT's safety and efficacy profiles in these patients.ObjectiveInvestigate the outcome of stroke patients already on anticoagulation/antiplatelet receiving MT.MethodsWe included consecutive acute ischemic stroke patients treated with MT for 10 years (2012-2022) in a comprehensive stroke center. Baseline variables, efficacy (recanalization [Thrombolysis in Cerebral Infraction] ≥ 2b), good functional outcome (modified Ranking Scale ≤ 2 at 3 months), and safety (symptomatic intracranial hemorrhage [sICH], mortality rates) were evaluated. Additionally, we conducted a subgroup analysis of patients with prior single-AP versus DAPT.ResultsSix hundred forty-six patients were included (54.5% women, median age 71 years), 84 (13%) were on AC, 196 (30.3%) on AP, and 366 (56.7%) in the control group. The AC and AP groups were older and had more comorbidities. sICH occurred in 7.3% of cases. There was no significant difference in sICH incidence across the groups. The AC group had a lower rate of intravenous thrombolysis (15.9%; P < 0.001), a higher rate of sICH (11.9% vs. AP 7.7% and control 6%; P = 0.172), and higher mortality at discharge (17.9% vs. AP 8.7% and control 10.4%; P = 0.07). However, the groups had similar functional outcomes and mortality rates at 3 months. Successful recanalization was achieved in 92.7% and was similar across groups. Multivariable logistic regression and the subgroup analysis (single-AP vs. dual AP) did not reveal statistically significant associations.ConclusionsMT in patients with prior anticoagulation and AP presenting with acute ischemic strokeis feasible, effective, and safe.Copyright © 2023 Elsevier Inc. All rights reserved.

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