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Zhang J, Huang X, Wang G, Wang X, Zhang T, Wang D, Qi L, Liang J, Li B, Chu J, Li K, Sun L, Song Y, Zhao W, Zheng M, Meng Y, Yin H, Wang W, Han J. Efficacy and Safety of Tirofiban Before Stenting for Symptomatic Intracranial Atherosclerotic Stenosis: A Randomized Clinical Trial. Neurology 2024; 102:e209217. [PMID: 38489544 DOI: 10.1212/wnl.0000000000209217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/21/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Acute stent thrombosis (AST) is not uncommon and even catastrophic during intracranial stenting angioplasty in patients with symptomatic high-grade intracranial atherosclerotic stenosis (ICAS). The purpose of this study was to investigate whether adjuvant intravenous tirofiban before stenting could reduce the risk of AST and periprocedural ischemic stroke in patients receiving stent angioplasty for symptomatic ICAS. METHODS A prospective, multicenter, open-label, randomized clinical trial was conducted from September 9, 2020, to February 18, 2022, at 10 medical centers in China. Patients intended to receive stent angioplasty for symptomatic high-grade ICAS were enrolled and randomly assigned to receive intravenous tirofiban or not before stenting in a 1:1 ratio. The primary outcomes included the incidence of AST within 30 minutes after stenting, periprocedural new-onset ischemic stroke, and symptomatic intracranial hemorrhage. The outcomes were analyzed using logistic regression analysis to obtain an odds ratio and 95% confidence interval. RESULTS A total of 200 participants (122 men [61.0%]; median [interquartile ranges] age, 57 [52-66] years) were included in the analysis, with 100 participants randomly assigned to the tirofiban group and 100 participants to the control (no tirofiban) group. The AST incidence was lower in the tirofiban group than that in the control group (4.0% vs 14.0%; adjusted odds ratio, 0.25; 95% CI 0.08-0.82; p = 0.02). No significant difference was observed in the incidence of periprocedural ischemic stroke (7.0% vs 8.0%; p = 0.98) or symptomatic intracranial hemorrhage between the 2 groups. DISCUSSION This study suggests that adjuvant intravenous tirofiban before stenting could lower the risk of AST during stent angioplasty in patients with symptomatic high-grade ICAS. TRIAL REGISTRATION INFORMATION URL: chictr.org.cn; Unique identifier: ChiCTR2000031935. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with symptomatic high-grade ICAS, pretreatment with tirofiban decreases the incidence of acute stent thrombosis. This study is Class II due to the unequal distribution of involved arteries between the 2 groups.
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Affiliation(s)
- Jun Zhang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Xin Huang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Guoqing Wang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Xianjun Wang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Tao Zhang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Dong Wang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Lifeng Qi
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Jiye Liang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Bing Li
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Jianfeng Chu
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Kai Li
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Lili Sun
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Yun Song
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Wei Zhao
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Meimei Zheng
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Yao Meng
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Hao Yin
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Wei Wang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Ju Han
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
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