Abstract 107: Rescue Tirofiban in Mechanical Thrombectomy for Acute Cerebral Large Artery Occlusion: A Multicenter Prospective Registry Study

Abstract

Background and Purpose: Preferred rescue treatment has not yet been recommended for recanalization refractory stroke patients during mechanical thrombectomy (MT). We aim to evaluate the safety and efficacy of rescue tirofiban in acute ischemic stroke(AIS) patients undergoing MT. Methods: We derived data from the ANGEL study, a multi-centric, prospective registry study that included MT patients owing to proximal large-artery occlusionfrom June 2015 to December 2017. Patients in this study were dichotomized into tirofiban and non-tirofiban group according to whether rescue tirofiban was performed during and after MT. Safety (symptomatic intracerebral hemorrhage [sICH], ICH and thrombus distalization) and efficacy outcomes (artery recanalization and functional outcomes at 3-month follow-up) were compared between groups. Results: We included 662 patients from the entire 917 patients in the Registry. Among them, there were 230 in tirofiban group and 432 in non-tirofiban group, and 47 (7.1%) patients suffered sICH and 102 (15.4%) suffered ICH within post-MT 24 hours; 33 (5.0%) experienced thrombus distalization; 289 (43.7%) achieved functional independence and 135 (20.4%) died after three-month follow-up. No significant differences of safety outcomes on sICH, ICH thrombus distalization and efficacy outcomes on artery recanalization and long-term functional independence were found between tirofiban and non-tirofiban groupeither for the entire cohort, anterior circulation stroke(ACS) patients or posterior circulation stroke(PCS) patients (p>0.05 for all groups). Yet, rescue tirofiban was significantly correlated with long-term mortality reduction for PCS patients (adjusted hazard ratio 0.35 [0.14-0.92], p=0.03). Conclusion: Rescue tirofiban during and after MT was not associated with increased risk of safety outcomes on sICH, ICH and thrombus distalization for AIS patients, and was correlated with long-term mortality reduction for PCS.