1Department of Surgery, Section of Neurosurgery, Ascension Providence Hospital, Southfield, Michigan.
2Central Michigan University College of Medicine, Mount Pleasant, Michigan; and.
Neurosurg Focus. 2023 Oct;55(4):E19. doi: 10.3171/2023.7.FOCUS23335.
The aim of this study was to demonstrate the safety and functional outcomes of antiplatelet use within 24 hours following mechanical thrombectomy (MT).
A retrospective review of prospectively collected data for consecutive patients who underwent MT for acute ischemic stroke (AIS) between 2016 and 2020 was performed. Patient demographics, comorbidities, Alberta Stroke Program Early CT Score (ASPECTS), antiplatelet use, neurological status, and tissue plasminogen activator use were collected. Patients were stratified into two groups, early (< 24 hours) or late (> 24 hours), based on when antiplatelet therapy was initiated post-MT. The primary outcome was safety, determined based on the rate of symptomatic intracranial hemorrhage (sICH) and inpatient mortality. The secondary outcome was functional independence (defined as modified Rankin Scale [mRS] score ≤ 2) at discharge and 30 days and 90 days postoperatively. The two cohorts were compared using univariate analysis. Multiple imputations were used to create complete data sets for missing data. Multivariable analysis was used to identify predictors for sICH and functional outcomes.
A total of 190 patients met inclusion criteria (95 per group). Significant differences between the early and late groups included sex, preoperative intravenous thrombolysis, angioplasty, stent placement, and thrombectomy site. ICH (symptomatic and asymptomatic) and inpatient mortality were not significantly different between the groups. The mRS score was significantly lower at discharge (p < 0.001), 30 days (p = 0.011), and 90 days (p = 0.024) following MT in the early group. Functional independence was significantly higher in the early antiplatelet group at discharge (p = 0.015) and at 30 days (p = 0.006). Early antiplatelet use was independently associated with significantly increased odds of achieving functional independence at discharge (OR 3.07, p = 0.007) and 30 days (OR 5.78, p = 0.004). Early antiplatelet therapy was not independently associated with increased odds of sICH.
Early antiplatelet initiation after MT in patients with AIS was independently associated with significantly increased odds of improved postoperative functional outcomes without increased odds of developing sICH.
本研究旨在证明在机械取栓（MT）后 24 小时内使用抗血小板药物的安全性和功能结果。
对 2016 年至 2020 年间连续接受 MT 治疗的急性缺血性卒中（AIS）患者前瞻性收集的数据进行回顾性分析。收集患者的人口统计学资料、合并症、阿尔伯塔卒中计划早期 CT 评分（ASPECTS）、抗血小板药物使用情况、神经状态和组织型纤溶酶原激活剂使用情况。根据 MT 后开始抗血小板治疗的时间，将患者分为两组，早期（<24 小时）或晚期（>24 小时）。主要结局是安全性，根据症状性颅内出血（sICH）和住院死亡率来确定。次要结局是出院时以及术后 30 天和 90 天时的功能独立性（定义为改良 Rankin 量表[mRS]评分≤2）。使用单变量分析比较两个队列。使用多重插补法创建缺失数据的完整数据集。使用多变量分析来确定 sICH 和功能结果的预测因素。
共纳入 190 例患者（每组 95 例）符合纳入标准。早期和晚期组之间的显著差异包括性别、术前静脉溶栓、血管成形术、支架置入和血栓切除术部位。两组之间的 ICH（症状性和无症状性）和住院死亡率无显著差异。早期组在 MT 后出院时（p<0.001）、30 天（p=0.011）和 90 天（p=0.024）时 mRS 评分显著较低。早期抗血小板组出院时（p=0.015）和 30 天时（p=0.006）的功能独立性显著更高。早期使用抗血小板药物与出院时（OR 3.07，p=0.007）和 30 天时（OR 5.78，p=0.004）功能独立性显著提高的几率显著增加独立相关。早期抗血小板治疗与 sICH 发生几率的增加无关。
AIS 患者 MT 后早期开始抗血小板治疗与术后功能结局显著改善的几率显著增加相关，而不会增加 sICH 的发生几率。
