Journal of Stroke and Cerebrovascular Diseases

2020

DOI: 10.1016/j.jstrokecerebrovasdis.2019.104619

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Efficacy and Safety of Low-Dose Tirofiban for Acute Intracranial Atherosclerotic Stenosis Related Occlusion with Residual Stenosis after Endovascular Treatment

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Baseline Characteristics Of the Included Studies2

Discussion2

Tirofiban1

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Cited by 31 publications

(34 citation statements)

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“…The Safety of Tirofiban sICH data were available for 2,450 patients from 12 studies [16,17,[19][20][21][22][23][24][25][26][27][28]. The incidence of sICH was 9.42% (81/860) in the tirofiban group and 10.38% (165/1,590) in the non-tirofiban group.…”

Section: Baseline Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Thirteen studies [16,17,[19][20][21][22][23][24][25][26][27][28][29] reported the mortality at 3-month in 3,077 patients with AIS with moderate heterogeneity (I 2 = 42%, p = 0.05). The tirofiban administration was associated with lower mortality; 200 of 1,080 patients died in the tirofiban group compared with 445 of 1,997 patients that died in the non-tirofiban group (OR = 0.75, 95% CI [0.62, 0.91], p = 0.003; shown in Fig.…”

Section: Baseline Characteristics Of the Included Studiesmentioning

confidence: 99%

See 1 more Smart Citation

The Application of Tirofiban in the Endovascular Treatment of Acute Ischemic Stroke: A Meta-Analysis

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2021

Cerebrovasc Dis

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<b><i>Objective:</i></b> The purpose of this meta-analysis is to evaluate the safety and efficacy of tirofiban during endovascular treatment (EVT) for acute ischemic stroke (AIS) patients. <b><i>Methods:</i></b> We systematically searched PubMed, Embase, Web of Science, and CENTRAL (Cochrane Central Register of Controlled Trials) databases for randomized controlled trials and cohort studies (published before May 1, 2020; no language restrictions) comparing tirofiban administration to blank control during EVT in patients with AIS. Our primary end points were the 3-month functional outcome, recanalization rate, symptomatic intracerebral hemorrhage, and 3-month mortality. <b><i>Results:</i></b> The incidence of 3-month modified Rankin Scale (mRS) 0–2 score of the tirofiban group was higher than that of the control group (odds ratio [OR] = 1.27, 95% CI [1.09, 1.48], <i>p</i> = 0.002) with heterogeneity (<i>I</i><sup>2</sup> = 34%, <i>p</i> = 0.11). Data pooled from the 6 studies describing the details of retriever stent in EVT revealed that tirofiban was associated with higher incidence of 3-month mRS 0–2 score (OR = 1.48, 95% CI [1.11, 1.96], <i>p</i> = 0.007). The recanalization rate was higher in the tirofiban group compared to the control group (OR = 1.66, 95% CI [1.16, 2.39], <i>p</i> = 0.006). There were no statistically significant differences in the incidence of symptomatic intracranial hemorrhage (OR = 0.97, 95% CI [0.73, 1.31], <i>p</i> = 0.86) and intracranial hemorrhage (OR = 1.08, 95% CI [0.59, 1.97], <i>p</i> = 0.80) between tirofiban and non-tirofiban group. Besides, the tirofiban administration was associated with lower mortality (OR = 0.75, 95% CI [0.62, 0.91], <i>p</i> = 0.003). <b><i>Conclusions:</i></b> The application of tirofiban in EVT of AIS may improve functional outcomes and reduce mortality at 3 months. Besides, tirofiban does not seem to increase the risk of symptomatic intracranial hemorrhage and intracranial hemorrhage, either in the anterior or posterior circulation stroke.

“…The Safety of Tirofiban sICH data were available for 2,450 patients from 12 studies [16,17,[19][20][21][22][23][24][25][26][27][28]. The incidence of sICH was 9.42% (81/860) in the tirofiban group and 10.38% (165/1,590) in the non-tirofiban group.…”

Section: Baseline Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Thirteen studies [16,17,[19][20][21][22][23][24][25][26][27][28][29] reported the mortality at 3-month in 3,077 patients with AIS with moderate heterogeneity (I 2 = 42%, p = 0.05). The tirofiban administration was associated with lower mortality; 200 of 1,080 patients died in the tirofiban group compared with 445 of 1,997 patients that died in the non-tirofiban group (OR = 0.75, 95% CI [0.62, 0.91], p = 0.003; shown in Fig.…”

Section: Baseline Characteristics Of the Included Studiesmentioning

confidence: 99%

The Application of Tirofiban in the Endovascular Treatment of Acute Ischemic Stroke: A Meta-Analysis

¹

,

²

,

³

2021

Cerebrovasc Dis

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<b><i>Objective:</i></b> The purpose of this meta-analysis is to evaluate the safety and efficacy of tirofiban during endovascular treatment (EVT) for acute ischemic stroke (AIS) patients. <b><i>Methods:</i></b> We systematically searched PubMed, Embase, Web of Science, and CENTRAL (Cochrane Central Register of Controlled Trials) databases for randomized controlled trials and cohort studies (published before May 1, 2020; no language restrictions) comparing tirofiban administration to blank control during EVT in patients with AIS. Our primary end points were the 3-month functional outcome, recanalization rate, symptomatic intracerebral hemorrhage, and 3-month mortality. <b><i>Results:</i></b> The incidence of 3-month modified Rankin Scale (mRS) 0–2 score of the tirofiban group was higher than that of the control group (odds ratio [OR] = 1.27, 95% CI [1.09, 1.48], <i>p</i> = 0.002) with heterogeneity (<i>I</i><sup>2</sup> = 34%, <i>p</i> = 0.11). Data pooled from the 6 studies describing the details of retriever stent in EVT revealed that tirofiban was associated with higher incidence of 3-month mRS 0–2 score (OR = 1.48, 95% CI [1.11, 1.96], <i>p</i> = 0.007). The recanalization rate was higher in the tirofiban group compared to the control group (OR = 1.66, 95% CI [1.16, 2.39], <i>p</i> = 0.006). There were no statistically significant differences in the incidence of symptomatic intracranial hemorrhage (OR = 0.97, 95% CI [0.73, 1.31], <i>p</i> = 0.86) and intracranial hemorrhage (OR = 1.08, 95% CI [0.59, 1.97], <i>p</i> = 0.80) between tirofiban and non-tirofiban group. Besides, the tirofiban administration was associated with lower mortality (OR = 0.75, 95% CI [0.62, 0.91], <i>p</i> = 0.003). <b><i>Conclusions:</i></b> The application of tirofiban in EVT of AIS may improve functional outcomes and reduce mortality at 3 months. Besides, tirofiban does not seem to increase the risk of symptomatic intracranial hemorrhage and intracranial hemorrhage, either in the anterior or posterior circulation stroke.

“…One possible explanation is the use of tirofiban. Studies [ 5 , 17 ] have shown that tirofiban, when delivered intra-arterially during a procedure, could dramatically reduce instant reocclusion during an endovascular procedure (85.7% reduction) as well as delayed reclusion on follow-up imaging (>70% reduction). Compared with the previous study, our study shows an even lower reocclusion rate with successful reperfusion.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with the previous study, our study shows an even lower reocclusion rate with successful reperfusion. In this study, the tirofiban treatment was intravenously administered earlier, before the endovascular procedure, and its antiplatelet efficacy might be further improved [ 17 ]. The intravenous administration of tirofiban might also explain the low intracranial hemorrhagic rate in this study [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of ICAS Patients: Targeting Reperfusion Rather than Residual Stenosis

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et al. 2022

Brain Sciences

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Background and Purpose: Previous studies showed that acute reocclusion after endovascular therapy is related to residual stenosis. However, we observed that reperfusion status but not residual stenosis severity is related to acute reocclusion. This study aimed to assess which factor mention above is more likely to be associated with artery reocclusion after endovascular treatment. Methods: This study included 86 acute ischemic stroke patients who had middle cerebral artery (MCA) atherosclerotic occlusions and received endovascular treatment within 24 h of a stroke. The primary outcomes included intraprocedural reocclusion assessed during endovascular treatment and delayed reocclusion assessed through follow-up angiography. Results: Of the 86 patients, the intraprocedural reocclusion rate was 7.0% (6/86) and the delayed reocclusion rate was 2.3% (2/86). Regarding intraprocedural occlusion, for patients with severe residual stenosis, patients with successful thrombectomy reperfusion showed a significantly lower rate than unsuccessful thrombectomy reperfusion (0/30 vs. 6/31, p = 0.003); on the other hand, for patients with successful thrombectomy reperfusion, patients with severe residual stenosis showed no difference from those with mild to moderate residual stenosis in terms of intraprocedural occlusion (0/30 vs. 0/25, p = 1.00). In addition, after endovascular treatment, all patients achieved successful reperfusion. There was no significant difference in the delayed reocclusion rate between patients with severe residual stenosis and those with mild to moderate residual stenosis (2/25 vs. 0/61, p = 0.085). Conclusion: Reperfusion status rather than residual stenosis severity is associated with artery reocclusion after endovascular treatment. Once successful reperfusion was achieved, the reocclusion occurrence was fairly low in MCA atherosclerosis stroke patients, even with severe residual stenosis.

“…23 Even in patients undergoing mechanical thrombectomy for occlusion with underlying intracranial atherosclerotic stenosis, tirofiban is associated with more favourable functional outcomes, lower mortality and lower rates of re-occlusion compared to controls without tirofiban (or other antiplatelet agents). 24 Moreover, during acute intraprocedural stent thrombosis in the context of intracranial atherosclerotic stenosis, intra-arterial bolus administration of tirofiban followed by IV infusion was efficacious and safe with no significant increased risk of intracranial hemorrhage or death. 25 With regards to mechanical thrombectomy, intra-arterial administration of tirofiban was beneficial predominantly for large artery atherosclerosis strokes relative to those of cardio-embolic origin.…”

Section: Tirofibanmentioning

confidence: 95%

Glycoprotein IIb/IIIa inhibitors for the neurointerventionalist

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et al. 2021

Interv Neuroradiol

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Antiplatelet therapies are commonly used in neurointerventional procedures. However, specific guidelines for their use in these settings is lacking and it can often be difficult to balance the potential risks and benefits of these medications. Considering the continued growth and adoption of neurointerventional procedures, it is crucial to understand the properties of these agents in order to use them safely. Large-scale clinical trials are still needed to clarify many of these aspects for this emerging field. However, the existing literature already provides insight into which antiplatelet drugs are of benefit to the neurointerventionalist as well as their associated risks of ischemic and hemorrhagic complications. Hence, this review focuses on the applications of GPIIb/IIIA inhibitors to neurointerventional procedures.

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