Abstract
Background and purpose: Tirofiban and oral antiplatelet drugs can be used to inhibit reocclusion and restore microvascular reperfusion during endovascular treatment (EVT). This study compared recanalization rates, symptomatic intracranial hemorrhage (SICH), 90 day mortality, and functional outcomes between periprocedural tirofiban and antiplatelet therapy in patients with acute intracranial atherosclerosis-related vertebrobasilar artery occlusion.Methods: A total of 105 consecutive patients with acute intracranial atherosclerosis-related vertebrobasilar artery occlusion who underwent EVT + tirofiban + oral antiplatelet or EVT + oral antiplatelet therapy at the Beijing Tiantan Hospital between January 2012 and July 2018 were included. Baseline characteristics, procedural parameters, and functional outcomes were assessed.Results: Among the 105 patients, 74 underwent EVT + tirofiban + oral antiplatelet therapy, while 31 underwent EVT + oral antiplatelet drug therapy. EVT + tirofiban + oral antiplatelet therapy resulted in higher recanalization rates compared to EVT + oral antiplatelet drug therapy (93.24% vs. 77.42%; p = 0.038), whereas the risk for SICH, 90 day mortality, and functional independence outcomes did not differ between the groups. Logistic regression analysis revealed that EVT + tirofiban + oral antiplatelet therapy had an increased probability of higher recanalization rates (OR 0.18 [95% confidence interval (CI) 1.24–24.39]; p = 0.025). There were no differences in SICH (OR 0.00 [95% CI 0.00–Inf]; p = 0.998), 90 day mortality (OR 1.19 [95% CI 0.17–4.05]; p = 0.826), or functional independence (modified Rankin score 0 to ≤ 2) (OR 1.43 [95% CI 0.23–2.17]; p = 0.538) between the groups.Conclusions: Ninety day functional outcomes of EVT + tirofiban + oral antiplatelet therapy were not superior to those of EVT + oral antiplatelet drug therapy; however, the recanalization rate was higher and the risks for SICH and 90 day mortality were lower.
Highlights
Many randomized trials have demonstrated the improved efficacy of endovascular treatment (EVT) compared with standard medical care in patients with acute ischemic stroke (AIS) caused by arterial occlusion in the anterior circulation [1,2,3,4,5]
The National Institutes of Health Stroke Scale (NIHSS) score was higher in patients who underwent EVT + tirofiban + oral antiplatelet drug therapy (25 [interquartile ranges (IQRs) 13–35] vs. 12 [IQR 10–23]; p = 0.005) than in those who underwent EVT + oral antiplatelet drug therapy (Table 1)
More patients in the EVT + tirofiban + oral antiplatelet drug therapy group required stent thrombectomy (77.03% vs. 45.16%; p = 0.001) than patients in the EVT + oral antiplatelet drug therapy group, and fewer patients required intraoperative heparinization (40.54% vs. 70.97%; p = 0.004), which may have been related to differences in the severity of neurological deficits at the time of admission between the two groups
Summary
Many randomized trials have demonstrated the improved efficacy of endovascular treatment (EVT) compared with standard medical care in patients with acute ischemic stroke (AIS) caused by arterial occlusion in the anterior circulation [1,2,3,4,5]. For acute intracranial atherosclerosis-related occlusion (ICASO), which is more common in Asia [11,12,13,14], salvage therapies [15], such as balloon angioplasty and stent angioplasty, are necessary to increase the rate of successful and complete reperfusion The associated risks, such as perforator occlusion [16], endothelial damage [17, 18], microvascular dysfunction [19], and reocclusion of recanalized vessels [20,21,22], may cause intracranial hemorrhage or even worse outcomes. This study compared recanalization rates, symptomatic intracranial hemorrhage (SICH), 90 day mortality, and functional outcomes between periprocedural tirofiban and antiplatelet therapy in patients with acute intracranial atherosclerosis-related vertebrobasilar artery occlusion
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