Studies blood thinner use with rescue stents in large vessel stroke
Observes blood thinner treatment and safety in adults with large vessel stroke receiving rescue stents.
Plain-language title generated from the registry record
Registry title: Rescue Stenting and Intravenous Thrombolysis In Patients With Large Vessel Ischemic Stroke
Key facts
- Where
- Bergamo, Cesena, Lecce, Milan, Monza, and Pietra Ligure, ItalySee the 7 sites
Where in Italy
- Asst Papa Giovanni XXIIIBergamo, ItalyTaking people
- Ospedale BufaliniCesena, ItalyTaking people
- Azienda Sanitaria Lecce - Ospedale "Vito Fazzi"Lecce, ItalyTaking people
- ASST Grande Ospedale Metropolitano NiguardaMilan, ItalyTaking people
- Asst Santi Paolo E CarloMilan, ItalyTaking people
- Fondazione IRCCS San Gerardo dei TintoriMonza, ItalyTaking people
- ASL 2 Savonese - Ospedale Santa CoronaPietra Ligure, ItalyTaking people
Questions to ask the study team
- How often do I need to come in, and for how long each time?
- Are travel costs paid?
- Can I keep my own doctor?
- What happens if I want to stop?
Trial details
- Who runs it
- ASST Santi Paolo e Carlo
- Trial code
- NCT06727006
- Record updated
- 17 December 2024
- Original description
Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are the standard of care for treating selected patients with acute large-vessel occlusion stroke (LVOS). Successful revascularization is strongly correlated with favorable outcomes. Nevertheless, recanalization failure with stent retrieval and contact aspiration has been observed in up to 29% of patients. If primary thrombectomy fails to achieve recanalization, rescue stenting (RS) has proven to be a feasible rescue therapy. Currently, approved evidence-based alternatives for LVOS patients who have failed MT are lacking, but permanent stenting is suggested as a rescue treatment in expert consensus statements.Read full original descriptionShow less
Stroke, Thrombolysis and Rescue Stenting
Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are the standard of care for treating selected patients with acute large-vessel occlusion stroke (LVOS). Successful revascularization is strongly correlated with favorable outcomes. Nevertheless, recanalization failure with stent retrieval and contact aspiration has been observed in up to 29% of patients. If primary thrombectomy fails to achieve recanalization, rescue stenting (RS) has proven to be a feasible rescue therapy. Currently, approved evidence-based alternatives for LVOS patients who have failed MT are lacking, but permanent stenting is suggested as a rescue treatment in expert consensus statements.
Dual antiplatelet therapy (DAPT), typically consisting of clopidogrel and aspirin, is recommended after stent implantation to reduce the risk of stent thrombosis; however, these medications are not suitable in the acute setting, and optimal platelet inhibition strategies remain unclear. Glycoprotein (GP) IIb/IIIa receptor inhibitors have intravenous administration, a rapid onset of action, and their effects subside within a few hours after discontinuation. For these reasons, an increasing number of studies have investigated their use in conjunction with primary stenting for acute stroke. Currently, there is no evidence supporting the superiority of any particular antithrombotic strategy, so decisions are guided by clinical judgment.
An additional challenge for clinicians arises when IVT is combined with stenting. Stroke guidelines recommend starting antiplatelets 24 hours after IVT and the risk associated with antithrombotic therapy within the first 24 hours after IVT remains uncertain.
This is multicenter, prospective, observational study of patients with LVOS undergoing mechanical thrombectomy and rescue stenting. The aim of this study is to evaluate real-world antithrombotic strategies in emergency stenting, particularly in patients treated with IVT, and to assess the safety of emergent stenting following intravenous thrombolysis.
Inclusion: Patients with large vessel occlusion strokes undergoing thrombectomy and rescue stenting within 24 hours of stroke onset; Patients ≥ 18 years of age.
Exclusion: Patients < 18 years; Refusal to give informed consent.