|
1
|
Sun Z, Huang S, Li W, Yang Y, Wu Y, Ma X, Nie X, Jin W, Liu C, Li X, Xu Y, Dong J, Liao Y, Sun B, Han W, Zhao Q, Chi H, Wang Y, Liu L, Zhang M. Preoperative and intraoperative tirofiban during endovascular thrombectomy in large vessel occlusion stroke due to large artery atherosclerosis. Eur J Neurol 2024; 31:e16419. [PMID: 39072930 DOI: 10.1111/ene.16419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/27/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND PURPOSE The aim of this study is to investigate the efficacy and safety of preoperative versus intraoperative tirofiban in patients with large vessel occlusion (LVO) due to large artery atherosclerosis (LAA). METHODS This is a retrospective multicenter cohort study based on the RESCUE-RE (Registration Study for Critical Care of Acute Ischemic Stroke After Recanalization) trial enrolling patients with anterior circulation LVO classified as LAA within 24 h of onset. Patients were divided into three groups: preoperative tirofiban (PT), intraoperative tirofiban (IT), and no tirofiban (NT). Propensity score matching (PSM) was used to balance baseline characteristics. The efficacy outcomes included 90-day functional independence (modified Rankin Scale score = 0-2) and early partial recanalization (EPR; defined as a modified Thrombolysis in Cerebral Infarction score = 1-2a). The safety outcomes included symptomatic intracranial hemorrhage (sICH). RESULTS A total of 104 matched triplets were obtained through PSM. Compared with NT, PT increased 90-day functional independence (60.8% vs. 42.3%, p = 0.008) and EPR (42.7% vs. 18.3%, p < 0.001) rate, with a tendency to increase the asymptomatic intracranial hemorrhage (aICH) proportion (28.8% vs. 18.3%, p = 0.072). Compared with IT, PT had a higher 90-day functional independence (60.8% vs. 45.2%, p = 0.025) and EPR (42.7% vs. 20.2%, p = 0.001) rate, with no significant difference in sICH (14.4% vs. 7.7%, p = 0.122) and aICH (28.8% vs. 21.2%, p = 0.200). Compared with NT, IT had a lower 90-day mortality rate (9.6% vs. 24.0%, p = 0.005). CONCLUSIONS Tirofiban shows good adjuvant therapy potential in acute ischemic stroke-LVO due to LAA patients. PT is associated with higher rates of EPR and better therapeutic efficacy. In addition, EPR may be a potential way to improve prognosis.
Collapse
Affiliation(s)
- Zhiqiang Sun
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Shuhan Huang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Li
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yi Yang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ya Wu
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xue Ma
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ximing Nie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wangsheng Jin
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Chengchun Liu
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xiaoshu Li
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yaning Xu
- Department of Neurology, 985 Hospital of Joint Logistics Support Force, Taiyuan, China
| | - Jun Dong
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yisi Liao
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Binlu Sun
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Wenjun Han
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Qing Zhao
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Huaqiao Chi
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yanjiang Wang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Meng Zhang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| |
Collapse
|
|
2
|
Ip B, Wang H, Yu SCH. Use of Tirofiban in Endovascular Thrombectomy: More Questions than Answers. Cardiovasc Intervent Radiol 2024; 47:216-217. [PMID: 38172252 DOI: 10.1007/s00270-023-03644-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Bonaventure Ip
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Hao Wang
- Department of Interventional Neurology, Linyi People's Hospital, Linyi, China
| | - Simon Chun Ho Yu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China.
| |
Collapse
|