Association of Intravenous Tirofiban with Functional Outcomes in Acute Ischemic Stroke Patients with Acute Basilar Artery Occlusion Receiving Endovascular Thrombectomy

Chen, Qiong; Meng, Renliang; Wu, Deping; Hu, Jinrong; Tao, Zhaojun; Xie, Dongjing; Tian, Yan; Han, Qin; Fang, Yuan; Zuo, Lei; Zhang, Min; Dai, Weipeng; Deng, Wei; Huang, Xianjun; Sang, Hongfei; Feng, Xinggang; Qiu, Zhongming; Wang, Tao; Yuan, Junjie

doi:10.1159/000527483

Cited by 5 publications

(9 citation statements)

References 25 publications

(38 reference statements)

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“…We conducted the sensitivity analysis in 2 ways: Changing the analytical model to a random effects model, with results consistent with the preliminary analysis (Figure S1, Supplemental Digital Content, http://links.lww.com/MD/J799 ); Individual studies were removed sequentially using the R software (4.4.2). Based on the sensitivity analysis (Figure S2, Supplemental Digital Content, http://links.lww.com/MD/J801 ), no statistically significant difference was seen between the tirofiban and control groups after the removal of Chen et al [ 26 ] in the pooled analysis of sICH rates (OR = 0.87, 95% CI = 0.43–1.78, P = .70). Other sensitivity analysis results were consistent with the preliminary analysis.…”

Section: Resultsmentioning

confidence: 98%

“…Third, previous studies have suggested that tirofiban has a better safety profile and lower risk of hemorrhage in patients with large atherosclerotic stroke compared with cardiogenic stroke. In 2 clinical studies of the posterior circulation, Chen et al [ 26 ] and Pan et al, [ 27 ] the tirofiban group had a significantly higher proportion of large artery atherosclerotic strokes. This was also the reason for the significantly lower rate of sICH in the tirofiban group in the posterior circulation subgroup.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the sensitivity analysis (Figure S2, Supplemental Digital Content, http://links.lww.com/MD/J801), no statistically significant difference was seen between the tirofiban and control groups after the removal of Chen et al [26] in the pooled analysis of sICH rates (OR = 0.87, 95% CI = 0.43-1.78, P = .70). Other sensitivity analysis results were consistent with the preliminary analysis.…”

Section: Sensitivity Analysismentioning

confidence: 99%

“…Single-center Cohort 180 (90/90) ACS + PCS MT/angioplasty/stenting 24 9 Chen et al [26] Pan et al [27] (2022) Multiple-center Cohort 130 (64/66) PCS (BA/VA) MT/angioplasty/stenting 25 9…”

Section: Recanalization Ratementioning

confidence: 99%

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Systematic review and meta-analysis of the efficacy and safety of adjunctive use of tirofiban in patients treated with endovascular therapy for acute ischemic stroke at different embolic sites

Liu,

Yang,

Liu

et al. 2023

Medicine

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Background: The use of tirofiban as an adjunct to endovascular therapy (EVT) for acute ischemic stroke has been controversial. We aimed to assess the differences in safety and efficacy of EVT adjuvant to tirofiban in patients with anterior circulation stroke (ACS) and posterior circulation stroke (PCS). Methods: We systematically searched Pubmed, Embase, Cochrane Library, and Web of Science. Cohort studies and randomized controlled trials that compared treatment with tirofiban combined with EVT and EVT alone were included in our meta-analysis. The safety outcomes were symptomatic intracranial hemorrhage, and 3-month mortality. The efficacy outcomes were good functional outcome, excellent functional outcome, and successful recanalization (mTICI ≥ 2b). We performed subgroup analyses of anterior and posterior circulation strokes. Results: We included 15 studies with 4608 patients. For safety outcomes, tirofiban significantly reduced 3-month mortality in the ACS subgroup (odd ratio [OR] = 0.80, 95% confidence interval [CI] = 0.65–0.98, P = .03) without increasing the rate of symptomatic intracranial hemorrhage (OR = 1.12, 95% CI = 0.88–1.44, P = .35). In the PCS subgroup, tirofiban significantly reduced 3-month mortality (OR = 0.63, 95% CI = 0.50–0.80, P = .0001) and symptomatic intracranial hemorrhage (OR = 0.60, 95% CI = 0.37–0.95, P = .03). For efficacy outcomes, in the ACS subgroup, tirofiban significantly improved good functional outcome (OR = 1.24, 95% CI = 1.06–1.45, P = .008) but did not improve recanalization (OR = 1.17, 95% CI = 0.93–1.47, P = .17) and excellent functional outcome (OR = 1.19, 95% CI = 0.97–1.46, P = .10). In the PCS subgroup, tirofiban significantly improved recanalization rate (OR = 1.94, 95% CI = 1.43–2.65, P < .0001) and did not improve good functional outcome (OR = 1.03, 95% CI = 0.81–1.30, P = .81) and excellent functional outcome (OR = 0.84, 95% CI = 0.58–1.20, P = .34). Conclusion: In acute ischemic stroke patients undergoing EVT, tirofiban improves good functional outcomes in ACS patients and increases recanalization rates in PCS patients on the 1 hand, reduces mortality, and does not increase the risk of symptomatic intracranial hemorrhage on the other. Tirofiban is safe and effective in both anterior circulation stroke and posterior circulation stroke patients undergoing EVT. More large multicentre randomized controlled studies are needed in the future.

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Sensitivity Analysismentioning

confidence: 99%

“…Single-center Cohort 180 (90/90) ACS + PCS MT/angioplasty/stenting 24 9 Chen et al [26] Pan et al [27] (2022) Multiple-center Cohort 130 (64/66) PCS (BA/VA) MT/angioplasty/stenting 25 9…”

Section: Recanalization Ratementioning

confidence: 99%

See 2 more Smart Citations

Systematic review and meta-analysis of the efficacy and safety of adjunctive use of tirofiban in patients treated with endovascular therapy for acute ischemic stroke at different embolic sites

Liu,

Yang,

Liu

et al. 2023

Medicine

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“…Ultimately, this meta-analysis incorporates a total of 15 papers that meet the inclusion criteria of the current research work (Supplementary material 2). Among these, one is a RCT study (4), 10 are retrospective studies (13)(14)(15)(16)(17)(18)(19)(20)(21)(22), and the last four are prospective studies (23)(24)(25)(26). A total of 4,329 patients from 15 selected studies are included.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

The efficacy and safety of continuous intravenous tirofiban for acute ischemic stroke patients treated by endovascular therapy: a meta-analysis

Wang,

Li,

Zhang

et al. 2024

Front. Neurol.

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IntroductionTirofiban is a non-peptide selective glycoprotein IIb/IIIa receptor inhibitor with a short half-life. The research assesses the efficacy and safety of continuous intravenous tirofiban in patients with acute ischemic stroke (AIS) undergoing endovascular therapy (ET).MethodsA systematic search of Pubmed, Embase, Web of Science, and Cochrane Library databases is conducted from inception until January 26, 2024. Eligible studies are included based on predefined selection criteria. Efficacy outcomes (favorable functional outcome and excellent functional outcome) and safety outcomes (symptomatic intracranial hemorrhage [sICH], any intracranial hemorrhage [ICH], and 90-day mortality) are calculated using odds ratios (OR) and 95% confidence intervals (CI).ResultsA total of 4,329 patients from 15 studies are included in the analysis. The results indicate a significant trend toward favorable functional outcomes in the tirofiban group (OR, 1.24; 95% CI, 1.09–1.42; p = 0.001). In terms of safety outcomes, tirofiban does not increase the risk of sICH (OR, 0.90; 95% CI, 0.71–1.13; p = 0.35) or any ICH (OR, 0.97; 95% CI, 0.70–1.34; p = 0.85), but it significantly decreases 90–day mortality (OR, 0.75; 95% CI, 0.64–0.88; p = 0.0006). A subgroup analysis suggests that continuous intravenous tirofiban demonstrates better efficacy (OR, 1.24; 95% CI, 1.09–1.42; p = 0.001) for patients with AIS undergoing rescue ET with even better results when used in combination with intra–arterial and intravenous administration (OR, 1.25; 95% CI, 1.07–1.451; p = 0.005).ConclusionContinuous intravenous tirofiban is effective and safe for patients with AIS undergoing rescue ET, particularly when combined with intra-arterial tirofiban.Systematic review registrationPROSPERO, identifier CRD42023385695.

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European Stroke Organisation (ESO) and European Society for Minimally Invasive Neurological Therapy (ESMINT) guideline on acute management of basilar artery occlusion

Strbian,

Tsivgoulis,

Ospel

et al. 2024

J NeuroIntervent Surg

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The aim of the present European Stroke Organisation (ESO) guideline is to provide evidence-based recommendations on the acute management of patients with basilar artery occlusion (BAO). These guidelines were prepared following the Standard Operational Procedure of the ESO and according to the GRADE methodology.Although BAO accounts for only 1–2% of all strokes, it has very poor natural outcome. We identified 10 relevant clinical situations and formulated the corresponding Population Intervention Comparator Outcomes (PICO) questions, based on which a systematic literature search and review was performed. The working group consisted of 10 voting members (five representing ESO and five representing the European Society of Minimally Invasive Neurological Therapy (ESMINT)) and three non-voting junior members. The certainty of evidence was generally very low. In many PICOs, available data were scarce or lacking, hence, we provided expert consensus statements.First, we compared intravenous thrombolysis (IVT) to no IVT, but specific BAO-related data do not exist. Yet, historically, IVT was standard of care for BAO patients who were also included (although in small numbers) in IVT trials. Non-randomized studies of IVT-only cohorts showed a high proportion of favorable outcomes. Expert Consensus suggests using IVT up to 24 hours unless otherwise contraindicated. We further suggest IVT plus endovascular treatment (EVT) over direct EVT. EVT on top of best medical treatment (BMT) was compared with BMT alone within 6 and 6–24 hours from last seen well. In both time windows, we observed a different effect of treatment depending on a) the region where the patients were treated (Europe vs Asia), b) on the proportion of IVT in the BMT arm, and c) on the initial stroke severity. In case of high proportion of IVT in the BMT group and in patients with a National Institutes of Health Stroke Scale (NIHSS) score below 10, EVT plus BMT was not found better than BMT alone. Based on very low certainty of evidence, we suggest EVT+BMT over BMT alone (this is based on results of patients with at least 10 NIHSS points and a low proportion of IVT in BMT). For patients with an NIHSS score below 10, we found no evidence to recommend EVT over BMT. In fact, BMT was non-significantly better and safer than EVT. Furthermore, we found a stronger treatment effect of EVT+BMT over BMT alone in proximal and middle locations of BAO compared with distal location. While recommendations for patients without extensive early ischemic changes in the posterior fossa can, in general, follow those of other PICOs, we formulated an Expert Consensus Statement suggesting against reperfusion therapy in those with extensive bilateral and/or brainstem ischemic changes. Another Expert Consensus suggests reperfusion therapy regardless of collateral scores. Based on limited evidence, we suggest direct aspiration over stent retriever as the first-line strategy of mechanical thrombectomy. As an Expert Consensus, we suggest rescue percutaneous transluminal angioplasty and/or stenting after a failed EVT procedure. Finally, based on very low certainty of evidence, we suggest add-on antithrombotic treatment during EVT or within 24 hours after EVT in patients with no concomitant IVT and in whom EVT was complicated (defined as failed or imminent re-occlusion, or need for additional stenting or angioplasty).

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Association of Intravenous Tirofiban with Functional Outcomes in Acute Ischemic Stroke Patients with Acute Basilar Artery Occlusion Receiving Endovascular Thrombectomy

Cited by 5 publications

References 25 publications

Systematic review and meta-analysis of the efficacy and safety of adjunctive use of tirofiban in patients treated with endovascular therapy for acute ischemic stroke at different embolic sites

Systematic review and meta-analysis of the efficacy and safety of adjunctive use of tirofiban in patients treated with endovascular therapy for acute ischemic stroke at different embolic sites

The efficacy and safety of continuous intravenous tirofiban for acute ischemic stroke patients treated by endovascular therapy: a meta-analysis

European Stroke Organisation (ESO) and European Society for Minimally Invasive Neurological Therapy (ESMINT) guideline on acute management of basilar artery occlusion

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