Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke

Abstract

RESCUE BT Trial Investigators E ndovascular treatment has been shown to significantly increase the reperfusion rate and improve the functional outcomes of patients with acute ischemic stroke due to large vessel occlusion. [1][2][3][4] However, endovascular thrombectomy has historically failed to yield successful reperfusion in approximately 30% of patients. 5 Unsuccessful reperfusion likely arises in part from mechanical thrombectomy devices causing traumatic damage to the vascular endothelium with subendothelial matrix exposure, leading to platelet activation, adhesion, and aggregation and potentially resulting in reocclusion and thromboembolic complications. 6,7 Tirofiban, a highly selective nonpeptide platelet glycoprotein IIb/IIIa inhibitor with a relatively short half-life that can reversibly prevent platelet aggregation, has been proven to reduce the risk of thrombotic complications during percutaneous coronary intervention. [8][9][10] Given the benefit of treatment of acute coronary syndromes, a growing number of studies have evaluated tirofiban as an adjunctive treatment in patients with large vessel occlusion ischemic stroke IMPORTANCE Tirofiban is a highly selective nonpeptide antagonist of glycoprotein IIb/IIIa receptor, which reversibly inhibits platelet aggregation. It remains uncertain whether intravenous tirofiban is effective to improve functional outcomes for patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy.OBJECTIVE To assess the efficacy and adverse events of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke secondary to large vessel occlusion.DESIGN, SETTING, AND PARTICIPANTS This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 55 hospitals in China, enrolling 948 patients with stroke and proximal intracranial large vessel occlusion presenting within 24 hours of time last known well.

Comparison of Safety and Efficacy after Emergency Stenting in Patients Exhibiting Intracranial Atherosclerotic Stenosis Associated with Large-vessel Occlusion with and without Intravenous Infusion of Tirofiban

“…These results are consistent with the primary safety outcome of the recent multicentre RESCUE BT trial among patients with acute ischaemic stroke due to largevessel occlusion undergoing endovascular thrombectomy and treatment with intravenous tirofiban compared with placebo [29]. In this trial, no significant difference was reported in the incidence of symptomatic intracranial haemorrhage between the groups.…”

New stress-induced hyperglycaemia markers predict prognosis in patients after mechanical thrombectomy

“…We may be able to explain this conclusion from a statistical point of view. The reperfusion success rate of the 5 major randomized trials was approximately 70%[ 1 ], whereas the recently published RESCUE BT study was as high as 90% [ 31 ], which may be attributed to the maturation and refinement of MT-related techniques. In contrast, in our study, the reperfusion success rate was 89.6% (favourable outcome,93.5% vs. poor outcome, 84.9%; P = 0.004).…”

Balloon Angioplasty as the First-Choice Treatment for Intracranial Atherosclerosis-Related Emergent Large Vessel Occlusion Involving the Microcatheter “First-Pass Effect”

“…Emergency balloon angioplasty’s major cause for concern is its increased risk of reocclusion without adequate antiplatelet therapy or cerebral hemorrhage when antiplatelet therapy is administered within 24 h of intravenous thrombolysis. Tirofiban is a short-acting intravenous antiplatelet drug widely used in percutaneous coronary intervention, and studies have proven that the combined use of tirofiban during or before EVT is feasible in patients with ICAS-ELVO 11 23-25 . Furthermore, tirofiban may be an alternative therapy for patients with post-MT ICAS-ELVO 26 .…”