目的：探讨血管内治疗急性动脉粥样硬化性颅内前循环大血管闭塞患者早期应用抗血小板药物的安 全性。方法：回顾性纳入因动脉粥样硬化性颅内前循环大血管闭塞引起的急性缺血性卒中（AIS）予以重组 组织型纤溶酶原激活剂（rt-PA）静脉溶栓桥接血管内治疗的患者56例。所有患者均于术中启用标准剂量替 罗非班，负荷剂量10 μg/kg静脉推注3 min，后以0.15 μg/(kg·min)持续泵至术后24 h。术后复查头颅CT排 除出血后给予口服阿司匹林100 mg联合氯吡格雷75 mg抗血小板聚集治疗。采用改良脑梗死溶栓分级 （mTICI）评估血管再通情况；参照ECASS Ⅱ标准评估颅内出血转化，观察3 d内颅内出血（ICH）、症状性颅 内出血（sICH）、其他系统出血发生率；观察患者术后3 d内、3月后死亡率；依据3月后患者改良Rankin评分 （mRS）评估日常独立生活能力。结果：56例急性前循环动脉粥样硬化性大血管闭塞患者中，术中实现血管 成功再通51例；3 d内发生ICH10例，其中sICH 4例，无其他系统出血；出现血小板减少2例，无颅内出血转 化；术后3 d内死亡2例，分别死于严重脑疝、重症肺炎。所有出院患者3月后均得到随访，mRS≤2分29例； 术后3月死亡7例。结论：对急性颅内前循环动脉粥样硬化性大血管闭塞接受静脉溶栓桥接血管内治疗的 患者，术中联用替罗非班治疗安全。

To explore the safety of early administration of platelet aggregation inhibitors in acute ischemic stroke patients who received endovascular intervention due to intracranial atherosclerotic large artery occlusion in the anterior circulation. Methods: This retrospective study included 56 acute ischemic stroke patients who received recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis (IVT) bridging endovascular treatment for atherosclerotic large vessel occlusion in the anterior circulation. During the procedure, all patients were treated with tirofiban with an intravenous bolus (10 μg/kg), followed by continuous IV application [0.15 μg/(kg·min)] for up to 24 h post-procedure and bridged with 100 mg aspirin and 75 mg clopidogrel dual oral antiplatelet treatment if the follow-up CT found no obvious hemorrhage. Recanalization result was assessed by catheter angiography according to the modified Thrombolysis in Cerebral Ischemia (mTICI) scale. Intracerebral hemorrhage was assessed for each patient using the European Cooperative Acute Stroke Study (ECASS) Ⅱ criteria, and the incidence of intracerebral hemorrhage (ICH), symptomatic intracranial hemorrhage (sICH), and systemic bleedings was recorded. Patient death 3 days and 3 months after surgery were recorded; 3-month functional outcomes were assessed by the modified Rankin scale (mRS)． Results: Among the 56 patients with large artery occlusion in the anterior circulation due to intracranial atherosclerotic disease, 51 patients received successful intraoperative recanalization; 10 subjects showed ICH in 3 days, 4 of which were sICH, and no patient experienced systemic bleedings. Thrombocytopenia occurred in 2 patients, neither of which had ICH. Within 3 days after operation, 2 patients died, one from cerebral hernia and the other from severe pneumonia. All patients were followed up for 3 months during which 7 patients died and 29 patients achieved a ≤2 mRS score. Conclusion: The use of tirofiban in intravenous thrombolysis bridging endovascular therapy in acute ischemic stroke patients with anterior circulation atherosclerotic large artery occlusion is safe.