Timing of dual antiplatelet therapy after emergent carotid artery stenting (eCAS) in acute ischemic stroke: results from the Madrid eCAS multicenter registry (MeCAS)
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Emergent carotid artery stenting (eCAS) is increasingly used in acute stroke due to tandem occlusion. However, the optimal timing for initiating dual antiplatelet therapy (DAPT) remains unknown. We analyze the effectiveness and safety of early versus delayed initiation of DAPT in a cohort of patients with acute stroke treated with eCAS. METHODS: Multicenter registry of patients treated with eCAS from 2019 to 2023. Main outcomes were stent occlusion/restenosis during follow-up, symptomatic intracranial hemorrhage (sICH) after DAPT, and good functional outcome at 3 months (modified Rankin scale (mRS) 0-2). Two timeframes for early DAPT initiation were considered: <12 hours after the procedure, and <24 hours. DAPT beyond 24 hours was considered as reference. RESULTS: 309 patients were included, 215 males (69.6%), mean (SD) age 67 (12.8) years. DAPT was initiated after eCAS in 270 patients (87.4%), <12 hours in 98 (36.3%), <24 hours in 198 (73.3%), and >24 hours in 72 (26.7%). At 3 months follow-up, stent occlusion/restenosis occurred in 25 patients (12.3%), and sICH after DAPT in 8 patients (3%); 141 (58%) achieved mRS 0-2. Early DAPT did not modify the risk of stent occlusion/restenosis: OR for DAPT <12 hours and DAPT <24 hours: 0.82 (95% CI 0.28 to 2.41) and 0.94 (95% CI 0.37 to 2.40), respectively, or sICH (OR 2.08 (95% CI 0.21 to 20.48) and 2.42 (95% CI 0.29 to 20.03)). Similarly, early DAPT did not improve the likelihood of mRS 0-2 (OR 1.76 (95% CI 0.92 to 3.69) and OR 1.30 (95% CI 0.74 to 2.28)). CONCLUSIONS: In this study, early DAPT initiation following eCAS did not modify the risk of late stent occlusion/restenosis, sICH, or the chance of achieving a good outcome at 3 months.
Authors: Isabel Lera Ramírez, Andrés García-Pastor, Alejandro Bonilla Tena, David Seoane, Patricia Calleja, Fernando Ostos, Elena de Celis, Carlos Gómez-Escalonilla, Patricia Simal, Alfonso López-Frías, Daniel Perez Gil, Rocio Vera Lechuga, Cristina Moreno López, José Fernández-Ferro, Maria Teresa Montalvo Moraleda, Javier Roa Escobar, Araceli García-Torres, Inmaculada Navas-Vinagre, Eduardo Escolar Escamilla, Rodrigo Terrero Carpio, Guillermo Martín Ávila, Ana Iglesias-Mohedano, Marta Vales Montero, Antonio Gil Núñez
Institutions: Hospital General Universitario Gregorio Marañón, Hospital Universitario 12 De Octubre, Hospital Universitario La Paz, Hospital Clínico San Carlos, Hospital Universitario Ramón y Cajal, Hospital Universitario Rey Juan Carlos, Hospital Universitario Fundación Jiménez Díaz, Hospital Universitario de Getafe
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7118607175