The Effect Of Preoperative Antiplatelet Drugs On The Short-term Prognosis Of Endovascular Therapy In Patients With Emergent Large Vessel Occlusive Stroke

Objective:Antiplatelet drug is one of the most important measures to prevent the recurrence of stroke.At present,about 20-43%of the stroke patients are using antiplatelet drug for secondary prevention.For this part of the population,recurrent stroke is treated by intravenous thrombolysis,thrombectomy and other measures.Whether antiplatelet drug will increase the risk of bleeding has been a topic of discussion.The purpose of this study is to investigate the effect of antiplatelet drugs on the short-term prognosis of patients with emergent large vessel occlusive stroke,so as to provide an effective basis for clinical treatment.Methods:From January 2015 to January 2020,acute ischemic stroke patients with emergent large vessel occlusion who were treated by mechanical thrombectomy in neurology department of the Fourth Affiliated Hospital of China Medical University were collected,and MRA,CTA or digital subtraction angiography(DSA)were performed to indicate that they were emergent large vessel occlusion.According to the inclusion and exclusion criteria,294 patients were included.According to whether antiplatelet drugs are used before thrombectomy,the patients were divided into two groups:AntiPlatelet Treatment(APT group)232 cases,non-AntiPlatelet Treatment(nAPT)62 cases.APT group was divided into four subgroups:single antiplatelet drug(aspirin or clopidogrel or tegril),dual antiplatelet drug(aspirin+clopidogrel),antiplatelet drug+anticoagulant,oral antiplatelet drug+intravenous antiplatelet drug(tirofiban).The sex,age,smoking history,drinking history,previous stroke history,hypertension history,diabetes history,atrial fibrillation history,antiplatelet drug application history,time from onset to visit,time from onset to groin artery puncture(onset to groin puncture,OTP),time from puncture to recanalization(punture to recanalization,PTR),systolic and diastolic blood pressure,preoperative NIHSS (National Institutes of Health Stroke Scale,NIHSS)score,postoperative NIHSS score,collateral circulation,vascular recanalization were recorded.SPSS 25.0 software was used to compare the above indexes between the two groups.T test or non-parametric test(U test)was used for the measurement data,chi-square test was used for the count data.Analysis of variance,chi-square test and H test were used for the subgroup analysis.Logistic regression analysis was used to analyze the impact of relevant factors on the incidence of sICH and the rate of vascular recanalization,P<0.05indicating that the difference was statistically significant.Result:1.The number of recanalization cases in APT group was higher than that in nAPT group(191 vs 34,c2=20.583,P=0.001),and the recanalization rate was higher(82.3%vs 54.8%,P=0.001).There was no significant difference in 3-month functional independence(29 vs 123,P=0.382),3-month mRS score(3.45±1.210 vs3.82±1.073,P=0.252),3-month mortality,symptomatic intracranial hemorrhage(5.6%vs 3.2%,P=0.571),and the time from puncture to recanalization(t=-0.367,P=0.714)between the two groups.Compared with nAPT group,AF in APT group was50 vs 17,X~2=0.957,P=0.328.Compared with nAPT group,the time from onset to femoral artery puncture(OTP)in APT group was t=-0.766,P=0.444.The PTR in APT group was 373.98±110.735 vs 359.97±94.651,t=-0.367,P=0.714.The systolic and diastolic blood pressure in APT group was 157±21.7 vs 151.13±21.791,t=0.967,P=0.326;88±12.3 vs 88.78±12.514,t=0.114,P=0.736.The preoperative NIHSS(National Institutes of Health Stroke Scale)score was 13.94±6.618 vs 15.07±6.824,t=-1.409,P=0.159.The Postoperative NIHSS score was7.13±3.380 vs 6.09±3.2,t=-1.037,P=0.300.The collateral circulation wasX~2=1.111,P=0.574,and the recanalization was 82.3%vs 54.8%,X~2=20.583,P=0.001.2.The results of the four subgroups of APT group showed that:one antiplatelet drug(Group 1),the group of double antiplatelet drugs(Group 2),antiplatelet drug+anticoagulant drug(Group 3),oral antiplatelet drug+intravenous antiplatelet drug(Group 4),The number of vascular recanalization in the oral plus intravenous antiplatelet drug group(Group 4)was higher than that in the other groups(34 vs 36 vs32 vs 16 vs 64,X~2=10.330,P=0.035),Group 4 had a high rate of revascularization(54.8%vs 58.0%vs 56.1%vs 55.1%vs 76.2%,X~2=10.330,P=0.035).There was no significant difference in 3-month functional independence(29 vs 33 vs 26 vs 17 vs 47,X~2=2.670,P=0.614),3-month mRS score(3.45±1.210 vs 3.66±1.173 vs 3.88±1.070vs 3.97±1.117 vs 3.86±0.984,F=1.892,P=0.112)and sICH(6.5%vs 6.5%vs 5.3%vs 13.8%vs 7.1%,X~2=2.327,P=0.676).The vascular recanalization rate(76.2%)of Group 4 is higher.There was no significant difference in the incidence of symptomatic intracranial hemorrhage(sICH).Antiplatelet therapy does not increase the incidence of sICH in patients with good collateral compensation(OR=0.9712,95%CI 0.465～1.789,P=0.788).However,antiplatelet therapy can increase the incidence of sICH in patients with poor collateral compensation(OR=2.239,95%CI 1.132～4.430,P=0.021).3.The three-month functional independence was negatively correlated with the time from onset to visit,that is,the longer the time from onset to visit,the worse the functional recovery was(OR=0.730,95%CI 0.562～0.949,P=0.019).4.The better the collateral circulation,the higher the recanalization rate was(OR=1.750,95%CI 1.277～2.399,P=0.001).The rate of revascularization was also related to CISS classification,and the rate of revascularization was higher in atherosclerotic group(OR=5.329,95%CI 3.119～9.103,P=0.001).In group1,group2and group4,Collateral circulation is positively correlated with vascular recanalization rate(OR=3.868,95%CI 1.512～9.898,P=0.005;OR=2.641,95%CI 1.282～5.441,P=0.008;OR=2.730,95%CI 1.384～5.386,P=0.004).Conclusion:1.Regular use of antiplatelet drugs can increase the recanalization rate of MT in patients with emergent large vessel occlusion.2.Regular use of antiplatelet drugs before hospitalization does not increase the risk of sICH in patients with emergent large vessel occlusion stroke.3.For the patients with emergent large vessel occlusion stroke,intravenous antiplatelet therapy before operation can increase the recanalization rate more than oral antiplatelet therapy,and does not increase the risk of sICH.4.For patients with emergent large vessel occlusion,the shorter the time from onset to treatment,from onset to femoral artery puncture and from puncture to recanalization,the better the management of blood pressure is,the better collateral circulation is,the better recanalization rate is,the less risk of sICH and the better three-month functional prognosis is.