Abstract TP51: Rescue Tirofiban During Mechanical Thrombectomy for Acute Ischemic Stroke Patients With Bridging Intravenous Thrombolysis

Abstract

Background and Purpose: Whether rescue tirofiban is safe and effective for acute ischemic stroke(AIS) patients undergoing mechanical thrombectomy (MT) with bridging intravenous thrombolysis (IVT) remains unclear. We aim to evaluate the safetyand efficacy of rescue tirofiban during MT in AIS patients treated with bridging IVT. 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 with bridging IVT were enrolled in the current study and 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 207 patientsfrom the entire 917 patients in the Registry. Among them, there were 55 in tirofiban group and 152 in non-tirofiban group, and 17 (8.2%) patients suffered sICH; 36 (17.4%) suffered ICH within 24 hours post-MT; 11 (5.3%) experienced thrombus distalization; 111 (53.6%) achieved functional independence and 34 (16.4%) died after three-month follow-up. No significant differences of safety outcomes on sICH, ICH and thrombus distalization and efficacy outcomes on artery recanalization and long-term functional independence were found between tirofiban and non-tirofiban group(p>0.05 for all groups). Yet, rescue tirofiban was significantly correlated with long-term mortality reduction for patients underwent MT with bridging IVT (adjusted hazard ratio 0.28 [0.08-0.94], adjusted p=0.03). Conclusion: In AIS patients underwent MT with bridging IVT, rescue tirofiban was not correlated with increased risk of safety outcomes on sICH, ICH or thrombus distalization and was associated with lower risk of long-term mortality