Abstract 343: Triple or Double? Safety Holds Steady in Acute Stenting

Background Acute stenting is typically performed for patients with focal neurological deficits due to carotid or intracranial atherosclerosis. Following the procedure, dual antiplatelet therapy (DAPT) regimen is prescribed to reduce the risk of in‐stent thrombosis. However, few studies have examined safety outcomes in patients already on oral anticoagulants (OACs) who undergo acute carotid or intracranial stenting with subsequent DAPTregimen. The combination of OACs and DAPT, referred here as triple therapy, is controversial given the increased risk of hemorrhagic transformation (HT). This study aims to analyze the safety of triple therapy in patients who undergo acute carotid or intracranial stenting by assessing differences in outcomes of patients who were on triple therapy or DAPT monotherapy. Methods A prospectively maintained endovascular database was reviewed to identify patients with focal neurological deficits requiring carotid or intracranial stenting between 2013 and 2025 at a comprehensive stroke center where patients were stratified based on prior anticoagulation. Demographics, manual ASPECTS (Alberta Stroke Program Early CT score), stroke risk factors, and admissions NIHSS (National Institute of Health Stroke Scale) scores were analyzed. Safety and functional outcomes assessed include HT, mass effect on CT, mortality, symptomatic and asymptomatic intracranial hemorrhage, and mRS (modified Rankin Scale) scores at discharge and three months. Patients with missing datapoints were excluded from analysis of that variable. NIHSS score at three months was excluded from analysis due to lack of triple therapy datapoints. Unstable regression coefficients in some safety variables due to sparsity were omitted. Results Of the 58 patients who met inclusion criteria of acute stenting, 18 were already on OACs, 72.2% of whom are male. There was a significant difference in rates of coronary artery disease (CAD, 44.4% triple therapy cohort vs. 12.5% DAPT‐only cohort, p=0.01) and hyperlipidemia (HLD, 77.8% triple therapy cohort vs. 45.0% DAPT‐only cohort, p=0.03). After adjusting for NIHSS score on admission, age, CAD, and HLD, discharge mRS was found to be significantly lower in the triple therapy group with median IQR scores of 3.5 1.75‐4 vs. 4 3‐5 in the DAPT only group. All other outcomes displayed no statistically significant difference between the two groups. Conclusion In this limited cohort study, triple therapy in patients already on anticoagulation undergoing acute carotid or intracranial stenting was not associated with increased harm. Our findings suggest improved functional outcomes at discharge without significant differences in safety or other outcomes, but is limited due to sparsity leading to unstable regression coefficients. image