What question did this study set out to answer?

This study aims to assess the safety and effectiveness of various antiplatelet therapy regimens during emergent intracranial stenting.

February 8, 2026Open Access

Impact of intraprocedural antiplatelet therapy on stent patency and safety after emergent intracranial stenting in acute ischaemic stroke: insights from the RESISTANT registry.

Key Points

This study aims to assess the safety and effectiveness of various antiplatelet therapy regimens during emergent intracranial stenting.
Subanalysis of the RESISTANT registry including patients treated with intracranial EIS from 2016 to 2023.
Evaluation of primary efficacy outcomes such as stent patency and 3-month modified Rankin Scale (mRS).
Analysis of secondary outcomes including successful reperfusion and symptomatic intracranial hemorrhage (sICH).
Use of multivariable and propensity score-matched analyses.
Among 827 patients, four antiplatelet strategies were identified with varying impacts on stent outcomes.
Intravenous agents showed a trend for lower intraprocedural stent occlusion risk compared to oral therapies.
GP IIb/IIIa inhibitors exhibited a protective trend at 24 hours, without increasing sICH risk.
Intravenous agents were associated with significantly higher odds of successful reperfusion.

Abstract

Introduction Emergent intracranial stenting (EIS) is increasingly employed in the context of the acute ischaemic stroke treatment, but requires intraprocedural antiplatelet therapy (APT), which may raise haemorrhagic risk. This study aimed to evaluate the safety and effectiveness of different APT regimens during EIS.Patients And Methods This is a subanalysis of the RESISTANT registry, which is a multicenter retrospective registry of patients with acute ischaemic stroke treated with intracranial EIS between 2016 and 2023. Patients receiving intraprocedural antithrombotics were included. Primary efficacy outcomes were stent patency (intraprocedural and within 24 hours) and 3-month mRS. Secondary outcome was successful reperfusion (modified thrombolysis in cerebral infarction ≥ 2b), and the safety outcome was sICH. Multivariable and propensity score-matched analyses were performed.Results Among 827 patients, 4 APT strategies were identified: single APT (n = 102), oral dual antiplatelet therapy (dAPT) (Aspirin + Clopidogrel or Ticagrelor; n = 83), Cangrelor (n = 92) and GP IIb/IIIa inhibitors (GPi) (n = 550). Intravenous agents (Cangrelor/GPi) showed a trend towards lower risk of intraprocedural stent occlusion compared to oral dAPT (adjusted odds ratio aOR 0.30, 95% CI, 0.09-1.01, P = .053), though this did not reach statistical significance. GP IIb/IIIa inhibitors continued to demonstrate a protective trend at 24 hours (aOR 0.25, 95% CI, 0.06-0.99, P = .047), without a significant increase in sICH. Both intravenous agents were independently associated with higher odds of successful final reperfusion (odds ratio OR 4.35, 95% CI, 1.57-12.09, P = .001). No significant differences emerged between GPi and Cangrelor in matched analysis. No significant difference was observed on good functional outcome between APT strategies.Conclusion In the setting of EIS, intravenous APT agents (Cangrelor or GPi) were associated with improved stent patency and higher rates of successful reperfusion, without a significant increase in symptomatic haemorrhage.

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