ABSTRACT NUMBER: ESOC2026A981 IMPACT OF ANTIPLATELET USE DURING MECHANICAL THROMBECTOMY IN ACUTE ISCHEMIC STROKE

Abstract Background and aims The use of antiplatelet agents during mechanical thrombectomy (MT) is increasing, particularly in complex procedures requiring intracranial or extracranial stenting. However, evidence regarding their safety and clinical impact remains limited and controversial. Methods We performed a retrospective analysis of a prospective, single-center registry including consecutive patients treated with MT between 2020 and 2024. Patients were classified according to the timing of antiplatelet initiation: during MT (intra-MT) or after MT (post-MT). Functional outcome at 3 months was assessed using the modified Rankin Scale (mRS). Safety outcomes included hemorrhagic transformation (HT), symptomatic intracranial hemorrhage (sICH), early neurological deterioration (END), and mortality. Results Among 635 patients treated with MT, 137 (21.6%) received intra-MT antiplatelet therapy (93.4% lysine acetylsalicylate, 6.6% tirofiban). Compared with the post-MT group, these patients were younger, more frequently male, smokers, and had a higher prevalence of atherothrombotic stroke etiology (all p<0.001). Stenting was performed in 74.5% of intra-MT patients. Intravenous thrombolysis use was similar between groups. Hemorrhagic transformation (42.3% vs 28.6%, p=0.002) and END (21.2% vs 13.7%, p=0.031) were more frequent in the intra-MT group. In multivariable analysis, intra-MT antiplatelet use was independently associated with a higher risk of HT, but not with END. No differences were observed in sICH, mortality, or favorable functional outcome (mRS 0–2). Conclusions Antiplatelet administration during MT is associated with an increased risk of hemorrhagic transformation but does not negatively impact symptomatic intracranial hemorrhage, mortality, or functional outcome at 3 months. Conflict of interest All authors: nothing to disclose