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

Tang, Luosheng; Tang, Xiangqi; Yang, Qianwen

doi:10.1159/000512601

Cited by 17 publications

(15 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In conclusion, our study failed to prove the efficacy of tirofiban in AVBAO patients who underwent MT. This finding was inconsistent with the results in ACO patients, which showed that tirofiban improved 3 months functional outcome and reduced the risk of 3 months death [30]. These discrepancies may be attributed to several reasons.…”

Section: Discussioncontrasting

confidence: 61%

“…Several studies have been conducted to evaluate the efficacy and safety of tirofiban in MT for ACO [24][25][26][27][28][29][30]. All of them were observational studies and some of them reported conflicting findings.…”

Section: Discussionmentioning

confidence: 99%

“…All of them were observational studies and some of them reported conflicting findings. A subsequent meta-analysis showed that for stroke patients (most of them were ACO), tirofiban combined with MT improved 3 months functional outcome, reduced the risk of 3 months death, and did not increase the risk of sICH [30]. As for AVBAO, the efficacy and safety evidence of tirofiban is limited.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Pan

Fei

et al. 2022

BMC Neurol

View full text Add to dashboard Cite

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.

show abstract

Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Pan

Fei

et al. 2022

BMC Neurol

View full text Add to dashboard Cite

show abstract

“…Tirofiban is classified as a platelet aggregation inhibitor that interferes with protein-protein interactions between fibrinogen and platelet integrin receptor GP IIb/IIIa. Recent studies have shown very promising results regarding the safety of intravenous tirofiban during stent deployment, including lowering of the incidence of procedure-related thrombosis without any increase in symptomatic ICHs [ 26 , 27 ]. In addition, the RS technique requires only one additional catheter passing through the pathologic artery and stent deployment while pulling backward, and the procedural yield is suspected to be much higher considering the small side effects.…”

Section: Discussionmentioning

confidence: 99%

“…the safety of intravenous tirofiban during stent deployment, including lowering of the incidence of procedure-related thrombosis without any increase in symptomatic ICHs [26,27]. In addition, the RS technique requires only one additional catheter passing through the pathologic artery and stent deployment while pulling backward, and the procedural yield is suspected to be much higher considering the small side effects.…”

Section: Plos Onementioning

confidence: 99%

Feasibility of rescue stenting technique in patients with acute ischemic stroke due to middle cerebral artery occlusion after failed thrombectomy: A single-center retrospective experience

Kim

Choi

2022

PLoS ONE

View full text Add to dashboard Cite

Background Despite remarkable advancements in intra-arterial mechanical thrombectomy (IAT), recanalization failure rates up to 24% have been reported. Recently, permanent stent placement (rescue stent, RS) during IAT has been suggested as an optional modality for better reperfusion and outcomes in these patients. However, previous studies were limited owing to non-standardized procedure protocols and small sample sizes. Here, we aimed to determine the efficacy and safety of RS in patients with acute ischemic stroke (AIS) with middle cerebral artery (MCA) occlusion. Methods Of the 243 patients in our IAT database (2015–2021), 183 were identified as having MCA occlusion alone. Among them, we extracted 53 patients in whom the IAT failed to show thrombolysis in cerebral ischemia (TICI) scores of 2A or worse. Intraoperatively, RS was deployed in 22 patients (RS group), whereas 31 patients (no-stent group) received IAT without stenting. The baseline characteristics and radiologic and clinical outcomes were reviewed. Comparisons between the groups and multivariate logistic analyses for recanalization and good functional outcomes (modified Rankin Scale 0–2) were performed. Results No baseline differences were noted (RS vs. no-stent); however, the recanalization outcomes (59.1% vs. 25.8%, p = 0.15) and proportion of good modified Rankin Scale scores (45.5% vs. 19.4%, p = 0.041) were better in the RS group. The parameters of symptomatic ICH (9.7% vs. 9.4%) and mortality (6.5% vs. 5.7%) showed no significant difference. In the multivariate analyses, ‘hypertension’ and ‘RS deployment’ were identified as significantly associated factors with recanalization and good prognosis. Conclusion In select patients with MCA occlusion AIS after failed IAT, the RS technique can be an optional rescue treatment modality for acquiring better functional outcomes and delayed recanalization.

show abstract

Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function

Liu,

Li,

Chen

et al. 2023

Ann Clin Transl Neurol

View full text Add to dashboard Cite

ObjectiveRenal function can modify the outcomes of large vessel occlusion (LVO) stroke across stroke etiologies in disparate degrees. The presence of renal function deficit can also impair the pharmacokinetics of tirofiban. Hence, this study aimed to investigate the roles of renal function in determining efficacy and safety of intravenous tirofiban before endovascular treatment (EVT) for acute ischemic stroke patients with large vessel occlusion (LVO).MethodsThis study was a post hoc exploratory analysis of the RESCUE‐BT trial. The primary outcome was the proportion of patients achieving functional independence (modified Rankin scale 0–2) at 90 days, and the primary safety outcome was the rate of symptomatic intracranial hemorrhage (sICH).ResultsAmong 908 individuals with available serum creatinine, decreased estimated glomerular filtration rate (eGFR) status was noted more commonly in patients with cardioembolic stroke (CE), while large artery atherosclerosis (LAA) was predominant in patients with normal renal function. In LAA with normal renal function, tirofiban was associated with higher rates of functional independence at 90 days (41.67% vs 59.80%, p = 0.003). However, for LVO patients with renal dysfunction, tirofiban did not improve functional outcomes for any of the etiologies (LAA, p = 0.876; CE, p = 0.662; others, p = 0.894) and significantly increased the risk of sICH among non‐LAA patients (p = 0.020). Mediation analysis showed tirofiban reduced thrombectomy passes (12.27%) and drug/placebo to recanalization time (14.25%) mediated its effects on functional independence.ConclusionThis present study demonstrated the importance of evaluating renal function before administering intravenous tirofiban among patients with LVO who are planned to undergo EVT.

show abstract

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

Cited by 17 publications

References 39 publications

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

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

Feasibility of rescue stenting technique in patients with acute ischemic stroke due to middle cerebral artery occlusion after failed thrombectomy: A single-center retrospective experience

Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function

Contact Info

Product

Resources

About