Abstract
BackgroundCompared with embolic occlusions, intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusions (LVOs) often require rescue treatment following mechanical thrombectomy (MT). Herein, we hypothesized that local tirofiban infusion can be effective and safe for remnant stenosis in LVO during endovascular treatment and can improve clinical outcomes.MethodsThis observational multicenter registry study (January 2011 to February 2016) included patients with ICAS who underwent endovascular treatment for LVO within 24 h after stroke onset. An underlying fixed focal stenosis at the occlusion site observed on cerebral angiography during and after MT was retrospectively determined as a surrogate marker of ICAS. Procedural and clinical outcomes were compared between the tirofiban and non-tirofiban groups.ResultsOf 118 patients, 59 received local tirofiban infusion. Compared to the non-tirofiban group, patients were older (non-tirofiban group versus tirofiban group; median, 63 years vs. 71 years, p = 0.015) and the onset-to-puncture time was longer (median, 275 min vs. 395 min, p = 0.036) in the tirofiban group. The median percent of residual stenosis prior to rescue treatment tended to be higher in the tirofiban group (80 [71–86] vs. 83 [79–90], p = 0.056). Final reperfusion success (modified Treatment In Cerebral Ischemic 2b–3) was more frequent (42.4%vs. 86.4%, p = 0.016) and post-procedure parenchymal hematoma type 2 and/or thick subarachnoid hemorrhages were less frequent (15.3%vs. 5.1%, p = 0.068) in the tirofiban group. The frequency of favorable outcomes 3 months after endovascular treatment (modified Rankin Scale 0–2) was significantly higher in the tirofiban group (32.2% vs. 52.5%, p = 0.025), and tirofiban administration was an independent predictor of favorable outcomes (odds ratio, 2.991; 95% confidence interval, 1.011–8.848; p = 0.048).ConclusionsLocal tirofiban infusion can be a feasible adjuvant treatment option for patients with ICAS-LVO.
Highlights
Compared with embolic occlusions, intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusions (LVOs) often require rescue treatment following mechanical thrombectomy (MT)
If the occlusion is caused by intracranial atherosclerotic stenosis (ICAS), these MT methods may not be sufficient for recanalization and reperfusion, and rescue treatment is frequently required following MT [6,7,8,9,10,11]
The criteria for inclusion were as follows: (1) patients had acute occlusion of the intracranial internal carotid artery (ICA), middle cerebral artery (MCA) M1, MCA M2, and vertebrobasilar artery; (2) the time from symptom onset to groin puncture was within 24 h; and (3) patients were diagnosed with ICAS-LVO, which was retrospectively evaluated on the cerebral angiography as the etiology of stroke
Summary
Intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusions (LVOs) often require rescue treatment following mechanical thrombectomy (MT). If the occlusion is caused by intracranial atherosclerotic stenosis (ICAS), these MT methods may not be sufficient for recanalization and reperfusion, and rescue treatment is frequently required following MT [6,7,8,9,10,11]. The endothelium of the ICAS can be injured by MT [19, 20] This thrombogenic milieu can cause thrombus propagation or reocclusion even after partial recanalization [6, 9, 21, 22]. Stabilization of thrombogenic lesions should be considered for ICASrelated LVO
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