Abstract Number: Esoc2026a1114 Antithrombotic Regimen After Emergent Carotid Artery Stenting and Risk of Early Complications: Results From a Population-Based Study

Abstract Background and aims Optimal periprocedural antithrombotic management during emergent carotid artery stenting (eCAS) for acute ischemic stroke due to tandem lesions (TL) remains controversial. Methods We conducted a population-based observational study in Catalonia, including consecutive patients with anterior circulation TL treated with endovascular therapy (EVT) and eCAS between January 2017 and March 2023. Emergent antithrombotic regimen initiated during eCAS was classified as high-intensity (dual antiplatelet therapy DAPT or anticoagulation) or low-intensity (single antiplatelet therapy or no antithrombotic therapy). The primary outcome was the presence of a relevant haemorrhagic transformation (HT) (any symptomatic intracerebral haemorrhage or parenchymal haemorrhage according to ECASS-II criteria). Secondary outcomes included 90-day modified Rankin Scale (mRS), a composite of 30-day mortality and ipsilateral ischaemic recurrence, and acute stent thrombosis within 72 hours. Logistic regression with an Inverse Probability of Treatment Weighting approach was used to adjust for confounding. Results Among 335 patients (mean age 70.4±10.2 years), 110 (32.8%) received high-intensity regimens. Relevant HT occurred in 57 (17.1%) patients and was less frequent in the high-intensity group (aOR 0.55, 95%CI 0.35–0.86). There were not significant differences after adjustment in functional outcome, 30-day composite outcome or acute stent thrombosis. The results remained after including only patients receiving DAPT at 24 hours. Conclusions In patients with TL treated with EVT and eCAS, emergent initiation of high-intensity antithrombotic therapy was not associated with increased HT risk. Both strategies (emergent initiation of high intensity regimen vs. deferred initiation at 24h) were similar in terms of functional outcome or early ischemic recurrences and mortality. Conflict of interest All autors declare nothing to disclose. On behalf of: Flores A, Guasch-Jiménez M, Lambea-Gil A, Prats-Sánchez L, Ramos-Pachón A, Martínez-Domeño A, Martí-Fàbregas J, Fernández-Vidal JM, Abilleira S, Salvat-Plana M and all Catalan Stroke Code and Reperfusion Consortium (CICAT) collaborators.