Assessing the Efficacy and Safety of Tirofiban in Combination With Dual-antiplatelet Therapy in Progressive Ischemic Stroke Patients

Safety and efficacy of coated flow diverters in the treatment of ruptured intracranial aneurysms: a retrospective multicenter study

BACKGROUND

This multicenter study evaluated the safety and efficacy of coated flow diverters (cFDs) for the treatment of ruptured intracranial aneurysms.

METHODS

Consecutive patients treated with different cFDs for ruptured aneurysms under tirofiban at eight neurovascular centers between 2016 and 2023 were retrospectively analyzed. The majority of patients were loaded with dual antiplatelet therapy after the treatment. Aneurysm occlusion was determined using the O'Kelly-Marotta (OKM) grading scale. Primary outcome measures were major procedural complications and aneurysmal rebleeding during hospitalization.

RESULTS

The study included 60 aneurysms (posterior circulation: 28 (47%)) with a mean size of 5.8±4.7 mm. Aneurysm morphology was saccular in 28 (47%), blister-like in 12 (20%), dissecting in 13 (22%), and fusiform in 7 (12%). Technical success was 100% with a mean of 1.1 cFDs implanted per aneurysm. Adjunctive coiling was performed in 11 (18%) aneurysms. Immediate contrast retention was observed in 45 (75%) aneurysms. There was 1 (2%) major procedural complication (a major stroke, eventually leading to death) and no aneurysmal rebleeding. A good outcome (modified Rankin Scale 0-2) was achieved in 40 (67%) patients. At a mean follow-up of 6 months, 27/34 (79%) aneurysms were completely occluded (OKM D), 3/34 (9%) had an entry remnant (OKM C), and 4/34 (12%) had residual filling (OKM A or B). There was 1 (3%) severe in-stent stenosis during follow-up that was treated with balloon angioplasty.

CONCLUSIONS

Treatment of ruptured aneurysms with cFDs was reasonably safe and efficient and thus represents a valid treatment option, especially for complex cases.

Safety and efficacy of tirofiban in the management of stroke: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

About 30 % of stroke patients have experienced unsuccessful reperfusion following endovascular therapy. Mechanical thrombectomy instruments may contribute to this by stimulating platelet aggregation. Tirofiban is a selective and rapidly activated antagonist of the platelets nonpeptide glycoprotein IIb/IIIa receptors that can reversibly suppress platelet aggregation. But, data from the medical literature are conflicting regarding its safety and efficacy for stroke patients. Hence, this study was designed to assess the safety and efficacy of tirofiban in stroke patients.

METHODS

Five major databases (PubMed, Scopus, Web of Science, Embase, and Cochrane library) were searched till December 2022. The Cochrane tool was used for risk of bias assessment, and the RevMan 5.4 was utilized for data analysis.

RESULTS

Seven RCTs with 2088 stroke patients were included. Tirofiban significantly increased the number of patients with mRS 0 score after 90 days than control; RR= 1.39, 95 %CI [1.15, 1.69]; p = 0.0006. Additionally, it reduced the NIHSS score after seven days; MD= -0.60, 95 %CI [-1.14, -0.06]; p = 0.03. However, tirofiban increased the incidence of intracranial haemorrhage (ICH); RR= 1.22, 95 %CI [1.03, 1.44]; p = 0.02. Other assessed outcomes showed insignificant results.

CONCLUSIONS

Tirofiban was associated with a higher mRS 0 score after three months and a lower NIHSS score after seven days. However, it is associated with higher ICH. Multicentric trials are required to provide more convincing proof of its utility.

Analysis of risk factors for the efficacy of tirofiban in the treatment of acute ischemic stroke

OBJECTIVE

To analyse the risk factors for tirofiban efficacy in the early treatment of acute ischemic stroke.

METHODS

The clinical data of 204 patients with acute ischemic stroke treated with tirofiban were retrospectively analysed. The early efficacy of tirofiban was assessed by a ≥ 4-point decline in the National Institutes of Health Stroke Scale (NIHSS) score or via the complete disappearance of neurological deficits at the end of ischemic stroke treatment, and patients were divided into an effective groupand an ineffective group. Univariate and multivariate logistic regression analyses were used to compare the differences in clinical data between the two groups.

RESULTS

 Multivariate logistic regression analysis showed that heavy drinking (OR 0.477, 95% CI 0.249-0.899, P = 0.023), elevated total cholesterol (OR 0.331, 95% CI 0.141-0.734, P = 0.008), NIHSS score at initiation of treatment (OR 1.130, 95% CI 1.026-1.253, P = 0.016) and time from onset to treatment (OR 0.839, 95% CI 0.700-0.979, P = 0.038) were independent risk factors affecting the early efficacy of tirofiban.

CONCLUSION

 The early curative effect of tirofiban in acute ischemic stroke patients with a heavy drinking history and elevated total cholesterol was poor. In patients with acute ischemic stroke, the higher the NIHSS score was within a certain range (8 < NIHSS ≤15 and the Org 10,172 Trial in the Treatment of Acute Stroke (TOAST) belongs to small-artery occlusion lacunar) at the initiation of treatment and the shorter the time from onset to treatment, the better the early curative effect was.

Branch atheromatous disease and treatment

Branch atheromatous disease (BAD) is a subtype of ischemic stroke caused by perforating arteries occlusion due to proximal atherosclerosis of the arteries. Early neurological deterioration and recurrent stereotyped transient ischemic attacks are typical clinical manifestations of BAD. The optimal treatment for BAD has not been determined. This article explores a possible mechanism of BAD and effective treatment measures to prevent early progression and attack of transient ischemic events. This article explains the current status of intravenous thrombolysis, tirofiban, and argatroban for BAD and subsequent prognosis.