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.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Risk factors and clinical outcomes associated with intracranial and extracranial atherosclerotic stenosis acute ischemic stroke.J Stroke Cerebrovasc Dis. 2014; 23: 1112-1117
- Stroke caused by atherosclerosis of the major intracranial arteries.Circ Res. 2017; 120: 502-513
- Immediate reocclusion following a successful thrombolysis in acute stroke: a pilot study.Neurology. 2003; 60: 1684-1687
- Vessel wall magnetic resonance imaging in acute ischemic stroke: effects of embolism and mechanical thrombectomy on the arterial wall.Stroke. 2014; 45: 2330-2334
- Emergent angioplasty and stent placement recanalization without thrombolysis in acute middle cerebral artery occlusions.J Stroke Cerebrovasc Dis. 2013; 22: 694-699
- Primary stent retrieval for acute intracranial large artery occlusion due to atherosclerotic disease.J Stroke. 2016; 18: 96-101
- Low-dose tirofiban improves functional outcome in acute ischemic stroke patients treated with endovascular thrombectomy.Stroke. 2017; 48: 3289-3294
- Endovascular treatment for emergent large vessel occlusion due to severe intracranial atherosclerotic stenosis.J Neurosurg. 2018; 1: 1-8
- Safety of intra-arterial tirofiban administration in ischemic stroke patients after unsuccessful mechanical thrombectomy.J Vasc Interv Radiol. 2019; 30: 141-147
- Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement.Stroke. 2013; 44: 2650-2663
- Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS study group. Alberta stroke programme early CT score.Lancet. 2000; 355: 1670-1674
- Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion.Stroke. 2008; 39: 2485-2490
- Collateral score complements clot location in predicting the outcome of intravenous thrombolysis.AJNR Am J Neuroradiol. 2014; 35: 1892-1896
- A standardized method for measuring intracranial arterial stenosis.AJNR Am J Neuroradiol. 2000; 21: 643-646
- Intravenous glycoprotein IIb/IIIa inhibitor (tirofiban) followed by low-dose intra-arterial urokinase and mechanical thrombolysis for the treatment of acute stroke.Neuroradiol J. 2011; 24: 907-913
- Intra-arterial adjuvant tirofiban after unsuccessful intra-arterial thrombolysis of acute ischemic stroke: preliminary experience in 16 patients.Neuroradiology. 2011; 53: 779-785
- The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy.Stroke. 2015; 46: 2981-2986
- Importance of truncal-type occlusion in stentriever-based thrombectomy for acute stroke.Neurology. 2016; 87: 1542-1550
- Incidence and clinical significance of acute reocclusion after emergent angioplasty or stenting for underlying intracranial stenosis in patients with acute stroke.AJNR Am J Neuroradiol. 2016; 37: 1690-1695
- Conformation-specific blockade of the integrin GPIIb/IIIa: a novel antiplatelet strategy that selectively targets activated platelets.Circ Res. 2006; 99: 25-33
- Safety and preliminary efficacy of early tirofiban treatment after alteplase in acute ischemic stroke patients.Stroke. 2016; 47: 2649-2651
- Predictors of unexpected early reocclusion after successful mechanical thrombectomy in acute ischemic stroke patients.Stroke. 2018; 49: 2643-2651
- Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials.Lancet. 2016; 387: 1723-1731
Article info
Publication history
Published online: January 22, 2020
Accepted:
December 19,
2019
Received in revised form:
December 15,
2019
Received:
November 29,
2019
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104619
Copyright
© 2019 Elsevier Inc. All rights reserved.