Jianhong Yang1, Yuefei Wu1, Xiang Gao2, Andrew Bivard3, Christopher R Levi4, Mark W Parsons3,4, Longting Lin4. 1. Department of Neurology (J.Y., Y.W.), Ningbo First Hospital, Zhejiang, China. 2. Department of Neurosurgery (X.G.), Ningbo First Hospital, Zhejiang, China. 3. Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Australia (A.B., M.W.P.). 4. School of Medicine and Public Health, University of Newcastle, Australia (C.R.L., M.W.P., L.L.).
Abstract
BACKGROUND AND PURPOSE: This study aimed to evaluate the treatment effect of intraarterial versus intravenous tirofiban during endovascular thrombectomy in acute ischemic stroke. METHODS: This study retrospectively examined 503 patients with acute ischemic stroke with large vessel occlusion who received endovascular thrombectomy within 24 hours of stroke onset. Patients were divided into 3 groups: no tirofiban (n=354), intraarterial tirofiban (n=79), and intravenous tirofiban (n=70). The 3 groups were compared in terms of recanalization rate, symptomatic intracerebral hemorrhage, in-hospital death rate, 3-month death, and 3-month outcomes measured by modified Rankin Scale score (good clinical outcome of 0-2, poor outcome of 5-6). The comparison was statistically assessed by propensity score matching, followed by Freidman rank-sum test and pairwise Wilcoxon signed-rank test with Bonferroni correction. RESULTS: The propensity score matching resulted in 92 matched triplets. Compared with the no-tirofiban group, the intravenous tirofiban group showed significantly increased recanalization (96.7% versus 64.1%, P<0.001), an increased rate of 3-month good outcome (69.5% versus 51.2%, P=0.034), and a lower rate of 3-month poor outcome (12.2% versus 41.4%, P<0.001). There was no significant difference between the tirofiban intravenous and no-tirofiban groups in terms of symptomatic intracerebral hemorrhage (2.2% versus 0%, P=1.000). However, symptomatic intracerebral hemorrhage was significantly increased in the intraarterial-tirofiban group compared with the no-tirofiban group (19.1% versus 0%, P<0.001), with an increased rate of in-hospital death (23.6% versus 0% P<0.001), and increased rate of 3-month death (26.8% versus 11.1%, P=0.021). The intraarterial-tirofiban and no-tirofiban group showed no significant difference in recanalization rate (66.3% versus 64.1%, P=1.000). CONCLUSIONS: As an adjunct to endovascular thrombectomy, intravenous tirofiban is associated with high recanalization rate and good outcome, whereas intraarterial tirofiban is associated with high hemorrhagic rate and death rate.
BACKGROUND AND PURPOSE: This study aimed to evaluate the treatment effect of intraarterial versus intravenous tirofiban during endovascular thrombectomy in acute ischemic stroke. METHODS: This study retrospectively examined 503 patients with acute ischemic stroke with large vessel occlusion who received endovascular thrombectomy within 24 hours of stroke onset. Patients were divided into 3 groups: no tirofiban (n=354), intraarterial tirofiban (n=79), and intravenous tirofiban (n=70). The 3 groups were compared in terms of recanalization rate, symptomatic intracerebral hemorrhage, in-hospital death rate, 3-month death, and 3-month outcomes measured by modified Rankin Scale score (good clinical outcome of 0-2, poor outcome of 5-6). The comparison was statistically assessed by propensity score matching, followed by Freidman rank-sum test and pairwise Wilcoxon signed-rank test with Bonferroni correction. RESULTS: The propensity score matching resulted in 92 matched triplets. Compared with the no-tirofiban group, the intravenous tirofiban group showed significantly increased recanalization (96.7% versus 64.1%, P<0.001), an increased rate of 3-month good outcome (69.5% versus 51.2%, P=0.034), and a lower rate of 3-month poor outcome (12.2% versus 41.4%, P<0.001). There was no significant difference between the tirofiban intravenous and no-tirofiban groups in terms of symptomatic intracerebral hemorrhage (2.2% versus 0%, P=1.000). However, symptomatic intracerebral hemorrhage was significantly increased in the intraarterial-tirofiban group compared with the no-tirofiban group (19.1% versus 0%, P<0.001), with an increased rate of in-hospital death (23.6% versus 0% P<0.001), and increased rate of 3-month death (26.8% versus 11.1%, P=0.021). The intraarterial-tirofiban and no-tirofiban group showed no significant difference in recanalization rate (66.3% versus 64.1%, P=1.000). CONCLUSIONS: As an adjunct to endovascular thrombectomy, intravenous tirofiban is associated with high recanalization rate and good outcome, whereas intraarterial tirofiban is associated with high hemorrhagic rate and death rate.
Authors: G Marnat; S Finistis; F Delvoye; I Sibon; J-P Desilles; M Mazighi; F Gariel; A Consoli; C Rosso; F Clarençon; M Elhorany; C Denier; V Chalumeau; J Caroff; L Veunac; F Bourdain; J Darcourt; J-M Olivot; R Bourcier; C Dargazanli; C Arquizan; S Richard; B Lapergue; B Gory Journal: AJNR Am J Neuroradiol Date: 2022-03-03 Impact factor: 3.825
Authors: Yan Zhang; Jianliang Wang; Zhaoxi Ma; Guihua Mu; Da Liang; Yifan Li; Xiaoyan Qian; Luyuan Zhang; Fang Shen; Lei Zhang; Jie Yu; Yang Liu Journal: Front Neurol Date: 2022-10-04 Impact factor: 4.086
Authors: G Marnat; F Delvoye; S Finitsis; B Lapergue; F Gariel; A Consoli; J-P Desilles; M Mazighi; C Dargazanli; R Bourcier; J Darcourt; V Chalumeau; M Elhorany; F Clarençon; S Richard; B Gory; I Sibon Journal: AJNR Am J Neuroradiol Date: 2021-06-11 Impact factor: 4.966