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
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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.
