Background 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. Methods 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. Results 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. Conclusion 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. Data are available upon reasonable request. The datasets generated and analysed during the current study are not publicly available, but anonymised data may be available from the corresponding author on reasonable request.

中文翻译：

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对于在机械血栓切除术期间需要紧急颅外支架置入术的患者来说，术中静脉注射阿司匹林安全吗？

背景 建议在机械血栓切除术 (MT) 期间进行紧急支架置入术时进行术中抗血小板治疗。大多数接受 MT 的患者还接受溶栓治疗。溶栓后 24 小时内禁用抗血小板药物。我们评估了 MT 期间使用或不使用静脉阿司匹林置入支架的患者的结果和并发症。方法 纳入 2010 年至 2020 年间在英国皇家斯托克大学医院 MT 期间接受紧急颅外支架置入术的所有患者。除非有禁忌症，患者在 MT 前接受溶栓治疗。术中根据操作者的判断给予阿司匹林 500 mg 静脉注射。第 7 天记录症状性颅内出血 (sICH) 和美国国立卫生研究院卒中量表评分 (NIHSS)，第 90 天记录死亡率和功能恢复（改良 Rankin 量表：mRS ≤2）。结果 在接受 MT 治疗的 565 名患者中，有 102 名患者（中位年龄 67 IQR 57-72 岁，基线中位 NIHSS 18 IQR 13-23，76 名（75%）已溶栓）放置了支架。其中 49 人 (48%) 服用阿司匹林，53 人 (52%) 没有服用。使用阿司匹林治疗的患者 NIHSS 改善更大（中位 8 IQR 1-16 分 vs 中位 3 IQR -9-8 分，p=0.003），但 sICH 方面没有显着差异（2/49 (4%) vs 9/53） (17%))、mRS ≤2 (25/49 (51%) vs 19/53 (36%)) 和死亡率 (10/49 (20%) vs 12/53 (23%))，无论是否服用阿司匹林。NIHSS 改善（中位数 12 IQR 4-18 对比中位数 7 IQR -7-10，p=0.01）更大，死亡率更低（4/33 (12%) 对比 6/15 (40%)，p=0.05）当阿司匹林与溶栓联合使用时，与单独使用阿司匹林相比，出血没有增加。结论 我们的研究结果基于来自常规临床护理的登记数据，表明在 MT 期间接受紧急支架置入术的患者中静脉注射阿司匹林不会增加 sICH，并且即使与静脉溶栓相结合，也能带来良好的临床结果。数据可根据合理要求提供。当前研究期间生成和分析的数据集不公开，但可根据合理要求从相应作者处获得匿名数据。