Neurosciences, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
Statistics and Mathematical Modelling, Department of Molecular Genetics, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands.
Stroke Vasc Neurol. 2024 Jun 21;9(3):279-288. doi: 10.1136/svn-2022-002267.
Intraoperative antiplatelet therapy is recommended for emergent stenting during mechanical thrombectomy (MT). Most patients undergoing MT are also given thrombolysis. Antiplatelet agents are contraindicated within 24 hours of thrombolysis. We evaluated outcomes and complications of patients stented with and without intravenous aspirin during MT.
All patients who underwent emergent extracranial stenting during MT at the Royal Stoke University Hospital, UK between 2010 and 2020, were included. Patients were thrombolysed before MT, unless contraindicated. Aspirin 500 mg intravenously was given intraoperatively at the discretion of the operator. Symptomatic intracranial haemorrhage (sICH) and the National Institutes for Health Stroke Scale score (NIHSS) were recorded at 7 days, and mortality and functional recovery (modified Rankin Scale: mRS ≤2) at 90 days.
Out of 565 patients treated by MT 102 patients (median age 67 IQR 57-72 years, baseline median NIHSS 18 IQR 13-23, 76 (75%) thrombolysed) had a stent placed. Of these 49 (48%) were given aspirin and 53 (52%) were not. Patients treated with aspirin had greater NIHSS improvement (median 8 IQR 1-16 vs median 3 IQR -9-8 points, p=0.003), but there were no significant differences in sICH (2/49 (4%) vs 9/53 (17%)), mRS ≤2 (25/49 (51%) vs 19/53 (36%)) and mortality (10/49 (20%) vs 12/53 (23%)) with and without aspirin. NIHSS improvement (median 12 IQR 4-18 vs median 7 IQR -7-10, p=0.01) was greater, and mortality was lower (4/33 (12%) vs 6/15 (40%), p=0.05) when aspirin was combined with thrombolysis, than for aspirin alone, with no increase in bleeding.
Our findings based on registry data derived from routine clinical care suggest that intraprocedural intravenous aspirin in patients undergoing emergent stenting during MT does not increase sICH and is associated with good clinical outcomes, even when combined with intravenous thrombolysis.
在机械血栓切除术（MT）期间，建议对紧急支架置入进行术中抗血小板治疗。大多数接受 MT 的患者也接受溶栓治疗。抗血小板药物在溶栓后 24 小时内禁用。我们评估了 MT 期间支架置入患者和未支架置入患者的结局和并发症。
纳入 2010 年至 2020 年期间在英国皇家斯托克大学医院接受紧急颅外支架置入的所有 MT 患者。除非有禁忌症，否则在 MT 前进行溶栓治疗。术中根据术者的判断给予静脉注射阿司匹林 500mg。记录 7 天的症状性颅内出血（sICH）和国立卫生研究院卒中量表评分（NIHSS），并在 90 天记录死亡率和功能恢复（改良 Rankin 量表：mRS≤2）。
在 565 例 MT 治疗患者中，102 例（中位年龄 67 IQR 57-72 岁，基线中位 NIHSS 18 IQR 13-23，76 例[75%]溶栓）放置了支架。其中 49 例（48%）给予阿司匹林，53 例（52%）未给予。接受阿司匹林治疗的患者 NIHSS 改善更大（中位数 8 IQR 1-16 与中位数 3 IQR -9-8 分，p=0.003），但 sICH（2/49[4%]与 9/53[17%]）、mRS≤2（25/49[51%]与 19/53[36%]）和死亡率（10/49[20%]与 12/53[23%]）无显著差异。与单独使用阿司匹林相比，阿司匹林联合溶栓治疗 NIHSS 改善（中位数 12 IQR 4-18 与中位数 7 IQR -7-10，p=0.01）更大，死亡率更低（4/33[12%]与 6/15[40%]，p=0.05），且出血无增加。
基于来自常规临床护理的登记数据，我们的研究结果表明，在 MT 期间紧急支架置入患者中，术中静脉内使用阿司匹林不会增加 sICH，并与良好的临床结局相关，即使与静脉内溶栓联合使用也是如此。
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