Abstract
Purpose: Tirofiban administration to acute ischemic stroke patients undergoing mechanical thrombectomy with preceding intravenous thrombolysis remains controversial. The aim of the current study was to evaluate the safety and efficacy of low-dose tirofiban during mechanical thrombectomy in patients with preceding intravenous thrombolysis.Methods: Patients with acute ischemic stroke undergoing mechanical thrombectomy and preceding intravenous thrombolysis were derived from “ANGEL-ACT,” a multicenter, prospective registry study. The patients were dichotomized into tirofiban and non-tirofiban groups based on whether tirofiban was administered. Propensity score matching was used to minimize case bias. The primary safety endpoint was symptomatic intracerebral hemorrhage (sICH), defined as an intracerebral hemorrhage (ICH) associated with clinical deterioration as determined by the Heidelberg Bleeding Classification. All ICHs and hemorrhage types were recorded. Clinical outcomes included successful recanalization, dramatic clinical improvement, functional independence, and mortality at the 3-month follow-up timepoint. Successful recanalization was defined as a modified Thrombolysis in Cerebral Ischemia score of 2b or 3. Dramatic clinical improvement at 24 h was defined as a reduction in NIH stroke score of ≥10 points compared with admission, or a score ≤1. Functional independence was defined as a Modified Rankin Scale (mRS) score of 0–2 at 3-months.Results: The study included 201 patients, 81 in the tirofiban group and 120 in the non-tirofiban group, and each group included 68 patients after propensity score matching. Of the 201 patients, 52 (25.9%) suffered ICH, 15 (7.5%) suffered sICH, and 18 (9.0%) died within 3-months. The median mRS was 3 (0–4), 99 (49.3%) achieved functional independence. There were no statistically significant differences in safety outcomes, efficacy outcomes on successful recanalization, dramatic clinical improvement, or 3-month mRS between the tirofiban and non-tirofiban groups (all p > 0.05). Similar results were obtained after propensity score matching.Conclusion: In acute ischemic stroke patients who underwent mechanical thrombectomy and preceding intravenous thrombolysis, low-dose tirofiban was not associated with increased risk of sICH or ICH. Further randomized clinical trials are needed to confirm the effects of tirofiban in patients undergoing bridging therapy.
Highlights
Endovascular treatment has proved to be effective for improving functional outcomes and reducing mortality in patients with large-artery occlusive stroke (1–7)
All patients were enrolled from the registry of “ANGEL-ACT,” which was a nationwide, multicenter, prospective registry study conducted in China from November 2017 to March 2019
A total of 1,793 consecutive patients who underwent endovascular treatment were initially recruited from the ANGEL-ACT registry, of which 201 were subsequently shortlisted based on the above-described criteria (Figure 1); 81 in the tirofiban group and 120 in the non-tirofiban group
Summary
Endovascular treatment has proved to be effective for improving functional outcomes and reducing mortality in patients with large-artery occlusive stroke (1–7). During the operative procedure, platelet aggregation caused by severe atherosclerotic stenosis or endothelial damage can lead to thrombotic events and early re-occlusion (8, 9). A number of studies have reported the effects of tirofiban during mechanical thrombectomy (MT), but outcomes are controversial (11–14). Few prospective studies have focused on tirofiban administration during MT in patients with preceding IVT, which is known as bridging therapy. The aim of the current prospective multicenter study was to evaluate the safety of tirofiban during MT with respect to symptomatic intracerebral hemorrhage (sICH) and intracerebral hemorrhage (ICH), as well as its efficacy during artery recanalization, and functional outcomes in patients who underwent bridging IVT
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