Tirofiban facilitates the reperfusion process during endovascular thrombectomy in ICAS

Abstract

Abstract. The aim of the present study was to assess the use of tirofiban injections for rescue therapy following artery reocclusion due to intra-luminal thrombosis during endovascular thrombectomy in patients with acute ischemic stroke (AIS). A total of seven cases of patients treated with adjunctive tirofiban injections following failed endovascular thrombectomy due to instant intra-luminal thrombosis were retrospectively assessed. A Solitaire stent was used as the primary thrombectomy device in all patients. Tirofiban was injected intra-arterially via a temporarily deployed Solitaire stent with continuous intravenous infusion for the subsequent 24 h; half of the conventionally recommended dose was employed. Outcome measures included angiographic reperfusion (mTICI), symptomatic intracranial hemorrhage, mortality and functional independence at 90 days (modified Rankin Scale, 0-2). Six patients had occlusions in the middle cerebral artery and one patient had occlusions in the basilar artery. Of the seven patients, five exhibited successful reperfusion (mTICI 2b-3) and achieved functional independence following 90 days. Reperfusion failed in the remaining two patients, who succumbed within 90 days of therapy. No intracranial or extracranial hemorrhage cases were identified. The results of the present study suggest that tirofiban facilitates reperfusion and ameliorates long-term prognosis in patients with AIS undergoing endovascular thrombectomy, and may be safe for those receiving intravenous tissue plasminogen activator therapy.

Intra-Arterial Glycoprotein IIb/IIIa Inhibitor Treatment for Symptomatic Intracranial Atherosclerotic Stenosis Presenting as Large Vessel Occlusions

“…The sole GPI treatment method treats the acute component of the stenosis, prevents its recurrence, avoids subjecting critically ill patients to the additional procedural risk of intracranial stenting, and allows for GPI titration if an intracerebral hemorrhage is found post-procedure. Our study corroborates the results from two recent studies by Zhao et al and Kang et al but distinguishes itself by including cases in which GPI is given as the first-line therapy in some cases identified as ICAS rather than as a rescue strategy after failed thrombectomy [ 14 - 15 ]. This technique may help reduce downstream embolization in these properly selected patients.…”

“…Intra-arterial GPI infusion in the setting of LVO stroke syndrome patients who often have received IV tPA prior to intervention raises the question of the safety of this approach with respect to increased intracerebral hemorrhage (ICH) risk. Kang et al and Zhou et al in addition to our data report symptomatic ICH complication rates of 0.7% and 0%, respectively, after GPI use in the setting of LVO secondary to ICAS [14][15]. A similar strategy of acute stenting in the setting of LVO occurs with tandem cervical carotid occlusions and intracranial occlusions [20].…”

“…Intra-arterial (IA) glycoprotein IIb/IIIa inhibitors (GPI), such as eptifibatide and tirofiban, are drugs that inhibit the GpIIb/IIIa receptor on the surface of platelets, thus preventing platelet aggregation and thrombus formation. Though commonly used for percutaneous coronary intervention, two groups recently attempted GPI use as a rescue remedy for ICAS patients after failed thrombectomy [ 14 - 15 ]. In this study, we report the first American experience using intra-arterial (IA) glycoprotein IIb/IIIa inhibitors (GPI) to achieve target vessel recanalization in patients undergoing acute stroke intervention procedures who were suspected intra-procedurally to have underlying ICAS.…”

Efficacy of Tirofiban Administered at Different Time Points after Intravenous Thrombolytic Therapy with Alteplase in Patients with Acute Ischemic Stroke

“…The patients underwent multi-modal MRI (T2W1, T1W1, and MRA) of the brain again after 24 hours of thrombolysis to assess the condition of recanalization of the blood vessels. The degree of recanalization was graded with the Thrombolysis in Myocardial Infarction (8) .579…”

Preliminary Experience of Neuroform Atlas Stenting as a Rescue Treatment after Failure of Mechanical Thrombectomy Caused by Residual Intracranial Atherosclerotic Stenosis

“…In the era of MT, it is important to determine the appropriate strategy for acute LAO refractory to conventional MT. In such cases, rescue therapies, including balloon angioplasty, stent angioplasty, and intra-arterial glycoprotein IIb/IIIa antagonist injection should be considered 13,24,28) . Moreover, stent angioplasty to restore blood flow should be considered, especially in Asian patients with atherosclerosis-related in situ stenosis or occlusion, because acute LAO with underlying intracranial atherosclerotic stenosis (ICAS) is more common in Asian populations than in Western populations 21) .…”