Intravenous Administration of Standard Dose Tirofiban after Mechanical Arterial Recanalization is Safe and Relatively Effective in Acute Ischemic Stroke

Cheng, Zhe; Xu, Geng; Gao, Jie; Hussain, Mohammed; Moon, Seong-Jin; Du, Hongguang; Ding, Yuchuan

doi:10.14336/ad.2018.0922

Cited by 27 publications

(25 citation statements)

References 39 publications

(38 reference statements)

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“…In the case of MT failure, the surgeon may use an adjuvant therapy that has not been tested for this indication by a RCT. A few of these therapies have been reported in small series: intra-arterial tPA ( 132 ), intra-arterial Urokinase ( 133 ), and intravenous Tirofiban ( 134 , 135 ). These series did not show significant association between these adjunctive therapies and sICH.…”

Section: Intracranial Bleeding After Reperfusion Therapy: Risk Factormentioning

confidence: 99%

Intracranial Bleeding After Reperfusion Therapy in Acute Ischemic Stroke

et al. 2021

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Intracranial hemorrhage is one of the most feared complications following brain infarct. Ischemic tissues have a natural tendency to bleed. Moreover, the first recanalization trials using intravenous thrombolysis have shown an increase in mild to severe intracranial hemorrhage. Symptomatic intracerebral hemorrhage is strongly associated with poor outcomes and is an important factor in recanalization decisions. Stroke physicians have to weigh the potential benefit of recanalization therapies, first, with different risks of intracranial hemorrhage described in randomized controlled trials, and second with numerous risk markers that have been found to be associated with intracranial hemorrhage in retrospective series. These decisions have become quite complex with different intravenous thrombolytics and mechanical thrombectomy. This review aims to outline some elements of the pathophysiological mechanisms and classifications, describe most of the risk factors identified for each reperfusion therapy, and finally suggest future research directions that could help physicians dealing with these complications.

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Section: Intracranial Bleeding After Reperfusion Therapy: Risk Factormentioning

confidence: 99%

Intracranial Bleeding After Reperfusion Therapy in Acute Ischemic Stroke

et al. 2021

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“…Endovascular therapy (EVT) is an innovative revascularization method that has changed the treatment course for large vessel occlusions. With the implementation of modern endovascular devices and techniques, over 80% of EVT-treated patients achieve successful reperfusion [ 6 , 7 ]. As the only multicenter randomized controlled trial investigating the efficacy and safety of EVT in BAO patients to date, Acute Basilar Artery Occlusion: Endovascular Interventions vs Standard Medical Treatment (BEST) trial was terminated prematurely due to excessive crossovers and a progressive drop in the average recruitment rate [ 8 ].…”

mentioning

confidence: 99%

Outcomes in Endovascular Therapy for Basilar Artery Occlusion: Intracranial Atherosclerotic Disease vs. Embolism

Wu¹,

Rajah²,

Cosky³

et al. 2021

Aging and disease

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Acute ischemic stroke due to basilar artery occlusion (BAO) carries a very poor prognosis. Functional outcomes in BAO patients undergoing endovascular therapy (EVT) may differ according to the specific pathological mechanisms. We aimed to explore the impact of the underlying pathological mechanisms on prognosis at 90-days and long-term follow-up in BAO patients treated with EVT. We analyzed consecutive BAO patients undergoing EVT from December 2012 to December 2018 at a single center (Xuanwu Hospital). Patients were classified into either an intracranial atherosclerotic disease (ICAD) group or an embolic group according to the corresponding angiographic findings. The baseline characteristics and functional outcomes were compared between the two groups. Multivariable logistic regression analysis was performed. Among the 167 patients enrolled, 78 patients (46.7%) were in the ICAD group and 89 patients (53.3%) were assigned to the embolic group. Overall, 149 patients (89.2%) achieved successful reperfusion post-EVT. There were no significant differences in functional outcomes at 90-days and long-term follow-up between the two groups. Similarly, a Kaplan-Meier survival analysis showed similar long-term survival probabilities (P = 0.438). The pathological mechanism was not associated with functional independence (OR, 1.818; 95% CI, 0.694-4.761; P = 0.224), favorable outcome (OR, 1.476; 95% CI, 0.592-3.681; P = 0.403), or mortality (OR, 1.249; 95% CI, 0.483-3.226; P = 0.646). However, based on subgroup analysis, embolic BAO versus ICAD was significantly associated with better functional independence in those aged 60 years and younger (OR, 4.513; 95% CI, 1.138-17.902). In this study, no differences in either 90days or long-term functional outcomes between ICAD-related BAO and embolic BAO patients undergoing EVT were observed. However, in BAO patients aged ≤ 60 years, the pathological mechanism of embolism was associated with better functional independence.

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“…Vascular recanalization via intravenous thrombolysis and mechanical thrombectomy has proven very effective under ideal circumstances, but due to a strict therapeutic window, the vast majority of AIS patients are ineligible for intravenous thrombolysis [ 5 ]. The inclusion criteria for mechanical thrombectomy are much more inclusive, but outcomes are suboptimal; less than half of patients achieve functional independence at 90 days post-thrombectomy, and 90-day survival is no different than in control groups [ 6 - 9 ]. Given the paucity of effective, accessible stroke therapies, the neurologic community is in desperate need of novel solutions.…”

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confidence: 99%

Intra-arterial Cold Saline Infusion in Stroke: Historical Evolution and Future Prospects

Wu¹,

Huber²,

Wu³

et al. 2020

Aging and disease

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Acute ischemic stroke (AIS) is a perpetual threat to life and functionality due to its high morbidity and mortality. In the past several decades, therapeutic hypothermia has garnered interest as an effective neuroprotective method in the setting of AIS. However, traditional hypothermic methods have been criticized for their low cooling efficiency and side effects. Intra-arterial cold saline infusion (IA-CSI), as a novel hypothermic method, not only minimizes these side effects, but is also perfectly integrated with widely accepted recanalization modalities in AIS, thereby serving as a promising prospect for clinical translation. In this article, we review the historical development of IA-CSI, summarize major studies of IA-CSI in rodents, large animals, and humans to date, and suggest insight into future development prospects in the field of AIS. We hope that this article will provide inspiration for the future application of hypothermia in AIS patients.

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Intravenous Administration of Standard Dose Tirofiban after Mechanical Arterial Recanalization is Safe and Relatively Effective in Acute Ischemic Stroke

Cited by 27 publications

References 39 publications

Intracranial Bleeding After Reperfusion Therapy in Acute Ischemic Stroke

Intracranial Bleeding After Reperfusion Therapy in Acute Ischemic Stroke

Outcomes in Endovascular Therapy for Basilar Artery Occlusion: Intracranial Atherosclerotic Disease vs. Embolism

Intra-arterial Cold Saline Infusion in Stroke: Historical Evolution and Future Prospects

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