Comparison of Safety and Efficacy after Emergency Stenting in Patients Exhibiting Intracranial Atherosclerotic Stenosis Associated with Large-vessel Occlusion with and without Intravenous Infusion of Tirofiban

Abstract

Purpose Intracranial rescue stent angioplasty is a bailout strategy for acute stroke patients in cases of unsuccessful endovascular thrombectomy due to underlying atherosclerotic stenosis. However, there is no consensus on a preprocedural and intraprocedural antiplatelet regimen. The aim of this single-centre study was to compare the safety and efficacy of emergency stenting in patients exhibiting intracranial atherosclerotic stenosis-related acute large-vessel occlusion with or without peri-interventional intravenous infusion of tirofiban. Materials and Methods We performed a retrospective analysis of 78 patients who were treated with rescuestent angioplasty between 2010 and 2019 due to acute ischaemic stroke. The patients were divided into 2 groups: those who received peri-interventional intravenous tirofiban and those who did not receive tirofiban. We compared clinical safety and functional outcomes in both treatment groups with symptomatic haemorrhage as the primary endpoint. Bivariate and multivariable logistic regression was performed to investigate the association between tirofiban and outcome measures. Results Thirty-seven patients were treated with intravenous tirofiban (47.4%), and 41 patients did not receive intravenous tirofiban (52.6%). Statistical analysis revealed no significant difference between the two groups in the rate of symptomatic haemorrhage (16.2% in the tirofiban group versus 14.6% in the control group, p = 0.847). The 3-month mortality (21.6% in the tirofiban group versus 17.1% in the control group, p = 0.611) and good functional outcomes according to the modified Rankin scale (45.9% versus 34.1%, p = 0.289) were comparable. Conclusion The results of our study suggest that the application of tirofiban for rescue stenting after failed mechanical thrombectomy is safe.

The efficacy and safety of continuous intravenous tirofiban for acute ischemic stroke patients treated by endovascular therapy: a meta-analysis

“…Ultimately, this meta-analysis incorporates a total of 15 papers that meet the inclusion criteria of the current research work (Supplementary material 2). Among these, one is a RCT study (4), 10 are retrospective studies (13)(14)(15)(16)(17)(18)(19)(20)(21)(22), and the last four are prospective studies (23)(24)(25)(26). A total of 4,329 patients from 15 selected studies are included.…”

Antithrombotic Therapy in Carotid Artery and Intracranial Artery Stent

“…52) Intravenous administration of GP IIb/ IIIa inhibitor has been reported to significantly improve functional outcomes and death at 90 days without increasing symptomatic ICH, 53) and several similar reports have been presented. 54) However, GP IIb/IIIa inhibitor has not yet been approved for use in Japan and this gap in drug approval between Western countries and Japan, as the so-called "drug lag," needs to be resolved.…”