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Research Article| Volume 29, ISSUE 4, 104619, April 2020

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

  • Zhizhong Yan
    Affiliations
    Department of Neurosurgery, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing Jiangsu Province, People's Republic of China

    Department of Neurosurgery, The 904th Hospital of the Joint Logistics Support force of Chinese People's Liberation Army, Wuxi Jiangsu Province, People's Republic of China
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  • Zhonghua Shi
    Affiliations
    Department of Neurosurgery, The 904th Hospital of the Joint Logistics Support force of Chinese People's Liberation Army, Wuxi Jiangsu Province, People's Republic of China
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  • Yuhai Wang
    Affiliations
    Department of Neurosurgery, The 904th Hospital of the Joint Logistics Support force of Chinese People's Liberation Army, Wuxi Jiangsu Province, People's Republic of China
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  • Chunlei Zhang
    Affiliations
    Department of Neurosurgery, The 904th Hospital of the Joint Logistics Support force of Chinese People's Liberation Army, Wuxi Jiangsu Province, People's Republic of China
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  • Jiaming Cao
    Affiliations
    Department of Neurosurgery, The 904th Hospital of the Joint Logistics Support force of Chinese People's Liberation Army, Wuxi Jiangsu Province, People's Republic of China
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  • Chunlong Ding
    Affiliations
    Department of Neurosurgery, The 904th Hospital of the Joint Logistics Support force of Chinese People's Liberation Army, Wuxi Jiangsu Province, People's Republic of China
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  • Mirui Qu
    Affiliations
    Department of Radiology, The 904th Hospital of the Joint Logistics Support force of Chinese People's Liberation Army, Wuxi Jiangsu Province, People's Republic of China
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  • Yunbao Xia
    Affiliations
    Department of Radiology, The 904th Hospital of the Joint Logistics Support force of Chinese People's Liberation Army, Wuxi Jiangsu Province, People's Republic of China
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  • Jin Cai
    Affiliations
    Department of Neurosurgery, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing Jiangsu Province, People's Republic of China
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  • Xin Zhang
    Correspondence
    Address correspondence to Handong Wang, MD, and Xin Zhang, MD Department of Neurosurgery, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, No. 305 Zhongshan East Road, Nanjing 210002 Jiangsu Province, People's Republic of China.
    Affiliations
    Department of Neurosurgery, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing Jiangsu Province, People's Republic of China
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  • Handong Wang
    Correspondence
    Address correspondence to Handong Wang, MD, and Xin Zhang, MD Department of Neurosurgery, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, No. 305 Zhongshan East Road, Nanjing 210002 Jiangsu Province, People's Republic of China.
    Affiliations
    Department of Neurosurgery, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing Jiangsu Province, People's Republic of China
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      Abstract

      Background: The optimal treatment strategy for residual stenosis in patients with acute intracranial atherosclerotic stenosis related occlusion (ICAS-O) after endovascular treatment (EVT) is unknown. This study aims to evaluate the efficacy and safety of low-dose tirofiban in patients with residual stenosis after EVT due to acute ICAS-O. Methods: Retrospective analysis of prospectively enrolled consecutive patients with residual stenosis after EVT due to acute ICAS-O from March 2015 to May 2019. Patients were divided into EVT alone group or EVT plus tirofiban group. The primary endpoint was the favorable functional outcome (defined as modified Rankin scale score of 0-2) at 90 days. The secondary endpoints were the proportions of reocclusion of recanalized arteries within 72 hours after EVT, symptomatic intracranial hemorrhage (sICH), any ICH, and mortality at 90 days. Logistic regression for predictors of reocclusion and functional outcomes were performed. Results: A total of 98 patients, 50 treated with tirofiban and 48 without tirofiban, were enrolled in this study. Compared with patients in EVT alone group, patients in EVT plus tirofiban group had higher favorable functional outcome rate, lower mortality, and a lower reocclusion rate (56.3% versus 30.4%; P = .014, 8.3% versus 28.3%; P = .016, and 10.4% versus 32.6%; P = .011, respectively). The rates of any ICH and sICH were similar between the 2 groups. The use of tirofiban was associated with the favorable functional outcome (odds ratio [OR], 3.417; 95% confidence interval [CI], 1.149-10.163; P = .027) and lower reocclusion rate (OR, 0.145; 95% CI, 0.038-0.546; P = .004) on multivariate logistic regression analysis. Conclusions: In patients with residual stenosis after EVT due to acute ICAS-O, a low-dose of tirofiban is associated with favorable functional outcome and reduced incidence of reocclusion without increasing any ICH and sICH.

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