To assess the efficacy and safety of periprocedural antiplatelet therapy in patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke (AIS) based on a network meta-analysis of randomized controlled trials (RCTs).

Antiplatelet therapy (APT) plays a crucial role in stroke prevention, but its role in the periprocedural period of MT is less clear. Existing trials have explored the benefits of antiplatelets, including tirofiban, in conjunction with MT. However, there is a lack of comprehensive comparison across trials evaluating their potential in preventing platelet aggregation and reducing reocclusion during MT.

A systematic search following PRISMA guidelines was performed across PubMed, Embase, Cochrane, and Web-of-Science for RCTs comparing antiplatelets before or during MT with no drug/placebo in AIS. Efficacy outcomes were functional independence at 90 days (modified Rankin Scale 0-2) and successful reperfusion (extended Thrombolysis in Cerebral Infarction score ≥2b). Safety outcomes were mortality at 90 days and symptomatic intracranial hemorrhage (sICH). We used frequentist network meta-analysis model, reporting odds ratios (ORs) with 95% confidence intervals (CIs).