Influence of tirofiban on stroke outcome after mechanical thrombectomy in acute vertebrobasilar artery occlusion

Abstract

Background Even undergoing mechanical thrombectomy (MT), patients with acute vertebrobasilar artery occlusion (AVBAO) still have a high rate of mortality. Tirofiban is a novel antiplatelet agent which is now widely empirically used in acute ischemic stroke (AIS). In this study, we aimed to evaluate the safety and efficacy of tirofiban as adjunctive therapy for MT in AVBAO. Methods From October 2016 to July 2021, consecutive AVBAO patients receiving MT were included in the prospective stroke registry. The short-term outcomes were (1) symptomatic intracerebral hemorrhage (sICH); (2) in-hospital death; (3) National Institute of Health Stroke Scale (NIHSS) at discharge. The Long-term outcomes were: (1) modified Rankin Scale (mRS) at 3 months; (2) death at 3 months. Results A total of 130 eligible patients were included in the study, 64 (49.2%) patients received tirofiban. In multivariate regression analysis, no significant differences were observed in all outcomes between the tirofiban and non-tirofiban group [sICH (adjusted OR 0.96; 95% CI, 0.12–7.82, p = 0.97), in-hospital death (adjusted OR 0.57; 95% CI, 0.17–1.89, p = 0.36), NIHSS at discharge (95% CI, -2.14–8.63, p = 0.24), mRS (adjusted OR 1.20; 95% CI, 0.40–3.62, p = 0.75), and death at 3 months (adjusted OR 0.83; 95% CI, 0.24–2.90, p = 0.77)]. Conclusions In AVBAO, tirofiban adjunctive to MT was not associated with an increased risk of sICH. Short-term (in-hospital death, NIHSS at discharge) and long-term outcomes (mRS and death at 3 months) seem not to be influenced by tirofiban use.

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

“…6). Sensitivity analysis showed that after the removal of the Pan et al [27] study, the I 2 value decreased to 0, suggesting a major source of heterogeneity.…”

“…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.…”

“…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…”

Association of tirofiban treatment with outcomes following endovascular therapy in cardioembolic stroke: insights from the RESCUE BT randomized trial

“…This approach would enable the identification of patients who are more likely to experience bleeding complications and facilitate the implementation of appropriate risk mitigation strategies. However, studies by X. Pan et al and Y. Wang et al provide conflicting results regarding the safety of tirofiban in endovascular stroke treatment [ 12 , 22 ]. X. Pan et al evaluated the safety and efficacy of tirofiban as adjunctive therapy in patients with acute vertebrobasilar artery occlusion undergoing mechanical thrombectomy.…”

Correction: Influence of tirofiban on stroke outcome after mechanical thrombectomy in acute vertebrobasilar artery occlusion

“…Following publication of the original article [ 1 ], the authors reported an error to author Jie Yang’s affiliation. Affiliation 5 was removed for author Jie Yang.…”