Efficacy and Safety Outcomes for Acute Ischemic Stroke Patients Treated with Intravenous Infusion of Tirofiban After Emergent Carotid Artery Stenting

Abstract

Introduction Emergent stenting of the extracranial internal carotid artery (ICA) in stroke patients requires antiplatelet therapy to prevent in-stent thrombosis with a higher risk of intracranial haemorrhage. Aim of the Study Assess the efficacy and safety of emergent carotid stenting with intravenous tirofiban in acute ischemic stroke patients. Methods Primary endpoint: symptomatic hemorrhage. Secondary endpoints: 90-day functional outcome and mortality. Results Of the 62 patients, 21 (34%) received tirofiban as a single antiplatelet, and 41 (66%) received combined therapy. Premedication with anticoagulants and antiplatelets was significantly more frequent in the tirofiban-only group. The rate of symptomatic haemorrhage was significantly lower in the tirofiban-only group than in the combined group (4.8% vs. 27%, p = 0.046). The patients with tirofiban alone had a significantly better functional outcome at day 90 than the combined group (52% vs. 24%, p = 0.028). Mortality was equal (24%) in both groups. Pre-interventional NIHSS score (p = 0.003), significant blood pressure fluctuations (p = 0.012), tandem occlusion (p = 0.023), and thrombolysis (p = 0.044) showed relevant influence on the rate of symptomatic hemorrhage in the entire patient cohort. Conclusions A single antiplatelet therapy with tirofiban regardless of the premedication may improve the functional outcome in patients with stroke due to acute extracranial carotid lesion and emergent carotid stenting with lower rates of serious intracranial haemorrhage. For patients with high pre-interventional NIHSS score, tandem occlusion and after pre-interventional thrombolysis, caution is advised. Additionally, strict blood pressure monitoring should be conducted during the first 72 h after intervention.

The Critical Balance: Understanding Blood Pressure and Intracranial Hemorrhage Association in Endovascular Stroke Therapy

“…On the other hand, high blood pressure, particularly during intravenous thrombolysis, carries the risk of intracranial hemorrhage, and low blood pressure can accelerate the breakdown of the collateral blood supply, leading to larger infarcts [ 1 ]. Post-therapy, both high blood pressure and high variability in blood pressure lead to poorer outcomes and increased risks of intracranial hemorrhage, especially when anticoagulant or antiplatelet drugs are necessary, such as in cases of extracranial stenting [ 2 ]. The nuances of blood pressure management during endovascular therapy are even less understood.…”