Abstract WP18: Tirofiban Cannot Prevent the Early Re-Occlusion After Endovascular Therapy in Acute Ischemic Stroke Patients

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Endothelial injury is inevitable after Endovascular thrombectomy (ET) in acute ischemic stroke, which may lead to early re-occlusion and attenuate the beneficial effects of ET. Tirofiban, a Glycoprotein(GP) IIb/IIIa antagonist, is often used to prevent local platelet aggregation and early re-occlusion. However, its effectiveness in preventing early re-occlusion is still unknown. Here, we investigate the efficacy of tirofiban in preventing early re-occlusion after ET. This observational study was based on a registry study. AIS patients treated with ET were recruited if they met one of the following criteria: treated with permanent intracranial stenting, balloon angioplasty, or >3 passes with retriever during thrombectomy. If used, a low dose bolus tirofiban (0.25 to 0.5 mg) was administrated intraarterially, followed by intravenous tirofiban continuously at a rate of 0.2 to 0.25 mg/h for 12 to 24 hours. Re-occlusion was defined as an in-situ re-thrombosis assessed by TCD and/or CTA within 7 days after ET. The primary outcome was the incidence of early re-occlusion within 7 days post-treatment. Eight one subjects (aged 60.6±12.2 years old) were included. There were 48 subjects treated with tirofiban and 33 subjects not treated with tirofiban. The median NIHSS at admission was 18 (12.5-25.5). Compared with 3 subjects (9.1%) treated without tirofiban, 4 subjects (8.0%) treated with tirofiban experience re-occlusion ( p =0.905). In Multivariate logistic regression analysis, tirofiban was also not associated with early re-occlusion ( p >0.05). 15 subjects (31.3%) experienced ICH in tirofiban group, compared with 13 (39.4%) in non-tirofiban group ( p =0.449). For sICH, 2 subjects (4.2%) from the tirofiban group versus 6 (18.2%) subjects from the tirofiban group ( p =0.089). At 3 months follow-up, compared with subjects treated without tirofiban, more subjects treated with tirofiban achieved independent walking ability (mRS 0-3) (18.2% vs. 2.0%, P =0.033). For a long term follow-up with a median time of 16 (2.5-28.0) months, no significant differences were found between two groups ( p >0.05). In conclusion, adjunct tirofiban in AIS patients treated with ET may not prevent early re-occlusion. But it may improve the functional outcome at 3 months after ET.