Abstract WP21: Different View on Clinical Application of Tirofiban After Mechanical Arterial Recanalization in Acute Ischemic Stroke

Abstract

Tirofiban, an antiplatelet drug and glycoprotein-IIb/IIIa inhibitor, widely used in cardiovascular events, appears to be safe and effective in cerebrovascular stroke. However, its efficacy post-endovascular therapy raised concern due to an association with increased risk of fatal intracerebral hemorrhage (ICH) and poor outcome in ischemic patients (Kellert et al. 2013). The success of 5 randomized clinical trials in stroke therapy in 2015 utilizing new generation endovascular intervention prompted this study of continuous intravenous administration of Tirofiban after thrombectomy with the Solitaire stent, one of the two new devices, in patients with acute ischemic stroke. A consecutive series of patients (n=28) who received Solitaire stent thrombectomy from January 2017 to the present was enrolled. 22 of the 28 patients were eligible for intravenous Tirofiban treatment for 24 h after receiving endovascular therapy. 6 patients were excluded because of no vessel recanalization, vessel recanalization achieved by other devices, or ICH after endovascular therapy. The incidence of symptomatic ICH and death was recorded. The number of thrombectomy attempts and device manipulation time within vessels were measured as potential markers for endothelial damage. The NIH stroke and modified Rankin scales were assessed at 7 days and 3 months, respectively. In all 22 patients who received Tirofiban after endovascular therapy, none had symptomatic ICH nor died from treatment. Successful recanalization rate (TICI≥2b) was achieved in 18 (86.4%) of 22 patients after endovascular therapy. As compared to the study by Kellert et al., the lower average device passages (1.2 vs 2.0) and short device manipulation time (56 vs 104 min) together suggested less endothelial damage. Of our patients, 77.3% showed neurological improvement at 7 days and 59.1% patients had favorable outcomes with a Modified Rankin scale of 0 to 2 at 3 months. These favorable outcomes were similar to those achieved in the 5 positive randomized trials. In conclusion, the continuous application of Tirofiban post-Solitaire stent thrombectomy appears to be safe and effective in acute ischemic stroke. Reduced endothelial damage may play a key role in clinical outcomes with Tirofiban application.