Intravenous Administration of Standard Dose Tirofiban after Mechanical Arterial Recanalization is Safe and Relatively Effective in Acute Ischemic Stroke.

Jie Gao,Mohammed Hussain,Xiaokun Geng,Seong-Jin Moon,Yuchuan Ding,Zhe Cheng,Huishan Du

doi:10.14336/ad.2018.0922

Abstract

To investigate the safety and efficacy of intravenous administration of a standard dose of glycoprotein-IIb/IIIa inhibitor tirofiban after vessel recanalization by mechanical thrombectomy in acute ischemic stroke. A consecutive series of patients (n=112) undergoing endovascular ischemic stroke intervention therapy were enrolled. 81 patients were eligible for intravenous (IV) tirofiban treatment for 24 hours after mechanical thrombectomy. The incidence of symptomatic intracranial hemorrhage (sICH), death, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) were assessed. In the 81 patients receiving tirofiban, 52 patients (64.2%) were treated with IV rt-PA before mechanical thrombectomy. sICH was found in 2 (2.5%) patients with no fatal ICH. Four patients died during 3 months after stroke onset. Successful recanalization with thrombolysis in cerebral infarction (TICI) score ≥2b was achieved in 75 of 81 patients (92.6%) after mechanical thrombectomy. The average number of passes with Solitaire stent retriever was 1.3. At 3 months, 55 of 81 patients (67.9%) had favorable outcomes (mRS<=2). The intravenous application of a standard dose of tirofiban post-Solitaire stent retriever thrombectomy and intravenous thrombolysis appears to be safe and relatively effective in acute ischemic stroke.

Highlights

Intravenous rt-PA is the first-line treatment in acute ischemic stroke (AIS) within 4.5 hours of symptom onset, its use is limited by a narrow therapeutic time window and relatively poor revascularization rates
Tirofiban after Thrombectomy in Stroke retrievers has been recommended as the first-line treatment in AIS patients with large vessel occlusions (LVO) based on the new American Heart Association/American Stroke Association (AHA/ASA) clinical guidelines [14]
The indications for tirofiban administration after endovascular therapy were as follows: 1) establishing a clinical diagnosis of AIS, 2) presence of intracranial LVO, 3) utilization of a second-generation mechanical thrombectomy device (Solitaire stent) for endovascular therapy, 4) vessel recanalization (TICI≥1), 5) no intracerebral hemorrhage (ICH) seen on computed tomographic (CT) head

Summary

Introduction

Intravenous rt-PA is the first-line treatment in acute ischemic stroke (AIS) within 4.5 hours of symptom onset, its use is limited by a narrow therapeutic time window and relatively poor revascularization rates. The recently published five multicenter prospective randomized trials have demonstrated the utility and benefit of second-generation mechanical thrombectomy (MT) devices (primarily stent retrievers) among patients with AIS due to LVO [9,10,11,12,13]. An inherent risk of endovascular therapies involving MT (stent retriever/aspiration), angioplasty and stenting is the associated damage to the inner endothelial cell lining of a blood vessel, which leads to local platelet aggregation and subsequent early reocclusion and resultant thromboembolic complications [17, 18]. Some studies have considered the usage of tirofiban to prevent early reocclusion and mitigate thromboembolic complications as an adjunct to endovascular therapy [17, 22] This application serves as an adjunct to MT in order to prevent local platelet aggregation [23, 24].

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Conclusion