BACKGROUND AND PURPOSE:The safety and efficacy of tirofiban during endovascular therapy in patients undergoing intravenous thrombolysis with recombinant IV tPA remain unclear. This study aimed to investigate the safety and efficacy of intra-arterial tirofiban use during endovascular therapy in patients treated with IV tPA. MATERIALS AND METHODS:Using a multicenter registry, we enrolled patients with acute ischemic stroke who underwent endovascular therapy. Safety outcomes included postprocedural parenchymal hematoma type 2 and/or thick subarachnoid hemorrhage, intraventricular hemorrhage, and 3-month mortality. Efficacy outcomes included the successful reperfusion rate, postprocedural reocclusion, and good outcomes at 3 months (mRS scores of 0-2). The tirofiban effect on the outcomes was evaluated using a multivariable analysis while adjusting for potential confounders.RESULTS: Among enrolled patients, we identified 314 patients with stroke (279 and 35 patients in the no tirofiban and tirofiban groups, respectively) due to an intracranial artery occlusion who underwent endovascular therapy with intravenous thrombolysis. A multivariable analysis revealed no association of intra-arterial tirofiban with postprocedural parenchymal hematoma type and/or thick subarachnoid hemorrhage (adjusted OR, 1.07; 95% CI, 0.20-4.10; P ¼ .918), intraventricular hemorrhage (adjusted OR, 0.43; 95% CI, 0.02-2.85; P ¼ .467), and 3-month mortality (adjusted OR, 0.38; 95% CI, 0.04-1.87; P ¼ .299). Intra-arterial tirofiban was not associated with good outcome (adjusted OR, 2.22; 95% CI, 0.89 -6.12; P ¼ .099).CONCLUSIONS: Using intra-arterial tirofiban during endovascular therapy after IV tPA could be safe.ABBREVIATIONS: aOR ¼ adjusted OR; EVT ¼ endovascular therapy; IA ¼ intra-arterial; ICAS-O ¼ intracranial atherosclerotic stenosis-related occlusion; IVT ¼ intravenous thrombolysis; LVO ¼ large-vessel occlusion; mTICI ¼ modified TICI

BACKGROUND AND PURPOSE:Patients with acute CTO generally have a poor prognosis, despite IV or IA thrombolytic treatment. The goal of this study was to analyze the results of patients with CTO who had IA urokinase treatment with or without initial IV rtPA based on a bridging protocol.