BACKGROUND AND PURPOSE:The relationship between reperfusion and clinical outcome is time-dependent, and the effect of reperfusion on outcome can vary on the basis of the extent of collateral flow. We aimed to identify the impact of time-to-reperfusion on outcome relative to baseline angiographic collateral grade in patients successfully treated with endovascular revascularization for acute large-vessel anterior circulation stroke.

BACKGROUND AND PURPOSE:The safety and efficacy of tirofiban during endovascular therapy in patients undergoing intravenous thrombolysis with recombinant IV tPA remain unclear. This study aimed to investigate the safety and efficacy of intra-arterial tirofiban use during endovascular therapy in patients treated with IV tPA. MATERIALS AND METHODS:Using a multicenter registry, we enrolled patients with acute ischemic stroke who underwent endovascular therapy. Safety outcomes included postprocedural parenchymal hematoma type 2 and/or thick subarachnoid hemorrhage, intraventricular hemorrhage, and 3-month mortality. Efficacy outcomes included the successful reperfusion rate, postprocedural reocclusion, and good outcomes at 3 months (mRS scores of 0-2). The tirofiban effect on the outcomes was evaluated using a multivariable analysis while adjusting for potential confounders.RESULTS: Among enrolled patients, we identified 314 patients with stroke (279 and 35 patients in the no tirofiban and tirofiban groups, respectively) due to an intracranial artery occlusion who underwent endovascular therapy with intravenous thrombolysis. A multivariable analysis revealed no association of intra-arterial tirofiban with postprocedural parenchymal hematoma type and/or thick subarachnoid hemorrhage (adjusted OR, 1.07; 95% CI, 0.20-4.10; P ¼ .918), intraventricular hemorrhage (adjusted OR, 0.43; 95% CI, 0.02-2.85; P ¼ .467), and 3-month mortality (adjusted OR, 0.38; 95% CI, 0.04-1.87; P ¼ .299). Intra-arterial tirofiban was not associated with good outcome (adjusted OR, 2.22; 95% CI, 0.89 -6.12; P ¼ .099).CONCLUSIONS: Using intra-arterial tirofiban during endovascular therapy after IV tPA could be safe.ABBREVIATIONS: aOR ¼ adjusted OR; EVT ¼ endovascular therapy; IA ¼ intra-arterial; ICAS-O ¼ intracranial atherosclerotic stenosis-related occlusion; IVT ¼ intravenous thrombolysis; LVO ¼ large-vessel occlusion; mTICI ¼ modified TICI