Zhongming Qiu1,2, Fengli Li1, Hongfei Sang3, Weidong Luo1,4, Shuai Liu1, Wenhua Liu5, Zhangbao Guo5, Huagang Li6, Dong Sun6, Wenguo Huang7, Min Zhang8, Min Zhang8, Weipeng Dai8, Peiyang Zhou9, Wei Deng9, Zhiming Zhou10, Xianjun Huang10, Bo Lei11, Jinglun Li12, Zhengzhou Yuan12, Bo Song13, Jian Miao14, Shudong Liu15, Zhenglong Jin16, Guoyong Zeng17, Hongliang Zeng17, Junjie Yuan1, Changming Wen18, Yang Yu18, Guangxiong Yuan19, Junxiong Wu19, Chen Long19, Jun Luo20, Zhenxuan Tian20, Chong Zheng21, Zhizhou Hu21, Shouchun Wang22, Tao Wang23, Li Qi24, Rongzong Li24, Yue Wan25, Yingbing Ke25, Youlin Wu26, Xiurong Zhu26, Weilin Kong1, Jiacheng Huang1, Daizhou Peng27, Mingze Chang28, Hanming Ge28, Zhonghua Shi29, Zhizhong Yan29, Jie Du30, Ying Jin31, Dongsheng Ju31, Chuming Huang32, Yifan Hong32, Tianzhu Liu33, Wenlong Zhao34, Jian Wang35, Bo Zheng35, Li Wang36, Shugai Liu37, Xiaojun Luo37, Shiwei Luo38, Xinwei Xu38, Jinrong Hu1, Jie Pu39,40, Shengli Chen41, Yaxuan Sun42, Shunfu Jiang43, Liping Wei44, Xinmin Fu45, Yongjie Bai46, Shunyu Yang47, Wei Hu48, Guling Zhang49, Chengde Pan50, Shuai Zhang51, Yan Wang52, Wenfeng Cao53, Shiquan Yang54, Jun Zhang55, Fuqiang Guo56, Hongbin Wen57, Jinhua Zhang58, Jiaxing Song1, Chengsong Yue1, Linyu Li1, Deping Wu1, Yan Tian1, Jie Yang1, Mengjie Lu59, Jeffrey L Saver60, Raul G Nogueira61, Wenjie Zi1, Qingwu Yang1,62. 1. Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China. 2. Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China. 3. Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China. 4. Department of Cardiovascular diseases, The General Hospital of Tibet Military Area Command, Lhasa, China. 5. Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China. 6. Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China. 7. Department of Neurology, Chinese Medical Hospital of Maoming, Maoming, China. 8. Department of Neurology, Jiangmen Central Hospital, Jiangmen, China. 9. Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China. 10. Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China. 11. Department of Cerebrovascular Diseases, Leshan People's Hospital, Leshan, China. 12. Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China. 13. Department of Neurosurgery, Xianyang Hospital of Yan'an University, Xianyang, China. 14. Department of Neurology, Xianyang Hospital of Yan'an University, Xianyang, China. 15. Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan, China. 16. Department of Neurology, Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China. 17. Department of Neurology, Ganzhou People's Hospital, Ganzhou, China. 18. Department of Neurology, Nanyang Central Hospital, Nanyang, China. 19. Department of Emergency, Xiangtan Central Hospital, Xiangtan, China. 20. Department of Neurology, Sichuan Mianyang 404 Hospital, Mianyang, China. 21. Department of Neurology, Longyan First Affliated Hospital of Fujian Medical University, Longyan, China. 22. Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China. 23. Department of Neurology, Huainan First People's Hospital, Huainan, China. 24. Department of Neurology, The 924th Hospital of The People's Liberation Army, Guilin, China. 25. Department of Neurology, The Third People's Hospital of Hubei Province, Wuhan, China. 26. Department of Neurology, Chongzhou People's Hospital, Chongzhou, China. 27. Department of Neurology, Qianxinan People's Hospital, Xingyi, China. 28. Department of Neurology, Xi'an Third Hospital, Xi'an, China. 29. Department of Neurosurgery, The 904th Hospital of The People's Liberation Army, Wuxi, China. 30. Department of Neurology, Kaizhou District People's Hospital, Kaizhou, China. 31. Department of Neurology, Songyuan Jilin Oilfield Hospital, Songyuan, China. 32. Department of Neurology, Shantou Central Hospital, Shantou, China. 33. Department of Neurology, Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, China. 34. Department of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China. 35. Department of Neurology, Ya'an People's Hospital, Ya'an, China. 36. Department of Neurology, The Third People's Hospital of Zigong, Zigong, China. 37. Department of Cerebrovascular Diseases, Guangyuan Central Hospital, Guangyuan, China. 38. Department of Neurology, Jieyang People's Hospital, Jieyang, China. 39. Department of Neurology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China. 40. Department of Neurology, People's Hospital of Wuhan University, Hubei General Hospital, Wuhan, China. 41. Department of Neurology, Chongqing University Three Gorges Central Hospital, Wanzhou, China. 42. Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China. 43. Department of Neurology, Jingdezhen First People's Hospital, Jingdezhen, China. 44. Department of Neurointervention, Luoyang Central Hospital, Luoyang, China. 45. Department of Neurology, Xuzhou Central Hospital, Xuzhou, China. 46. Department of Neurology, The First Affiliated Hospital of Henan Science and Technology University, Luoyang, China. 47. Department of Neurology, The First People's Hospital of Yunnan Province, Kunming, China. 48. Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China. 49. Department of Neurology, Danzhai County People's Hospital, Danzhai, China. 50. Department of Neurology, Banan District People's Hospital, Banan, China. 51. Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou, China. 52. Department of Neurology, The Fifth People's Hospital of Chengdu, Chengdu, China. 53. Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China. 54. Department of Neurology, The 902nd Hospital of The People's Liberation Army, Bengbu, China. 55. Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China. 56. Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China. 57. Department of Neurology, Xiangyang Central Hospital, Hubei Arts and Science University, Xiangyang, China. 58. Department of Neurology, Sir Run Run Shaw Hospital affiliated to Zhejiang University, Hangzhou, China. 59. School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China. 60. Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California. 61. Department of Neurology, Marcus Stroke & Neuroscience Centre, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia. 62. Chongqing Institute for Brain and Intelligence, Guangyang Bay Laboratory, Chongqing 400064, China.
Abstract
Importance: Tirofiban is a highly selective nonpeptide antagonist of glycoprotein IIb/IIIa receptor, which reversibly inhibits platelet aggregation. It remains uncertain whether intravenous tirofiban is effective to improve functional outcomes for patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy. Objective: To assess the efficacy and adverse events of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke secondary to large vessel occlusion. Design, Setting, and Participants: This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 55 hospitals in China, enrolling 948 patients with stroke and proximal intracranial large vessel occlusion presenting within 24 hours of time last known well. Recruitment took place between October 10, 2018, and October 31, 2021, with final follow-up on January 15, 2022. Interventions: Participants received intravenous tirofiban (n = 463) or placebo (n = 485) prior to endovascular thrombectomy. Main Outcomes and Measures: The primary outcome was disability level at 90 days as measured by overall distribution of the modified Rankin Scale scores from 0 (no symptoms) to 6 (death). The primary safety outcome was the incidence of symptomatic intracranial hemorrhage within 48 hours. Results: Among 948 patients randomized (mean age, 67 years; 391 [41.2%] women), 948 (100%) completed the trial. The median (IQR) 90-day modified Rankin Scale score in the tirofiban group vs placebo group was 3 (1-4) vs 3 (1-4). The adjusted common odds ratio for a lower level of disability with tirofiban vs placebo was 1.08 (95% CI, 0.86-1.36). Incidence of symptomatic intracranial hemorrhage was 9.7% in the tirofiban group vs 6.4% in the placebo group (difference, 3.3% [95% CI, -0.2% to 6.8%]). Conclusions and Relevance: Among patients with large vessel occlusion acute ischemic stroke undergoing endovascular thrombectomy, treatment with intravenous tirofiban, compared with placebo, before endovascular therapy resulted in no significant difference in disability severity at 90 days. The findings do not support use of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR-IOR-17014167.
Importance: Tirofiban is a highly selective nonpeptide antagonist of glycoprotein IIb/IIIa receptor, which reversibly inhibits platelet aggregation. It remains uncertain whether intravenous tirofiban is effective to improve functional outcomes for patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy. Objective: To assess the efficacy and adverse events of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke secondary to large vessel occlusion. Design, Setting, and Participants: This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 55 hospitals in China, enrolling 948 patients with stroke and proximal intracranial large vessel occlusion presenting within 24 hours of time last known well. Recruitment took place between October 10, 2018, and October 31, 2021, with final follow-up on January 15, 2022. Interventions: Participants received intravenous tirofiban (n = 463) or placebo (n = 485) prior to endovascular thrombectomy. Main Outcomes and Measures: The primary outcome was disability level at 90 days as measured by overall distribution of the modified Rankin Scale scores from 0 (no symptoms) to 6 (death). The primary safety outcome was the incidence of symptomatic intracranial hemorrhage within 48 hours. Results: Among 948 patients randomized (mean age, 67 years; 391 [41.2%] women), 948 (100%) completed the trial. The median (IQR) 90-day modified Rankin Scale score in the tirofiban group vs placebo group was 3 (1-4) vs 3 (1-4). The adjusted common odds ratio for a lower level of disability with tirofiban vs placebo was 1.08 (95% CI, 0.86-1.36). Incidence of symptomatic intracranial hemorrhage was 9.7% in the tirofiban group vs 6.4% in the placebo group (difference, 3.3% [95% CI, -0.2% to 6.8%]). Conclusions and Relevance: Among patients with large vessel occlusion acute ischemic stroke undergoing endovascular thrombectomy, treatment with intravenous tirofiban, compared with placebo, before endovascular therapy resulted in no significant difference in disability severity at 90 days. The findings do not support use of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR-IOR-17014167.
Authors: Gregory W Albers; Michael P Marks; Stephanie Kemp; Soren Christensen; Jenny P Tsai; Santiago Ortega-Gutierrez; Ryan A McTaggart; Michel T Torbey; May Kim-Tenser; Thabele Leslie-Mazwi; Amrou Sarraj; Scott E Kasner; Sameer A Ansari; Sharon D Yeatts; Scott Hamilton; Michael Mlynash; Jeremy J Heit; Greg Zaharchuk; Sun Kim; Janice Carrozzella; Yuko Y Palesch; Andrew M Demchuk; Roland Bammer; Philip W Lavori; Joseph P Broderick; Maarten G Lansberg Journal: N Engl J Med Date: 2018-01-24 Impact factor: 91.245
Authors: Raul G Nogueira; Ashutosh P Jadhav; Diogo C Haussen; Alain Bonafe; Ronald F Budzik; Parita Bhuva; Dileep R Yavagal; Marc Ribo; Christophe Cognard; Ricardo A Hanel; Cathy A Sila; Ameer E Hassan; Monica Millan; Elad I Levy; Peter Mitchell; Michael Chen; Joey D English; Qaisar A Shah; Frank L Silver; Vitor M Pereira; Brijesh P Mehta; Blaise W Baxter; Michael G Abraham; Pedro Cardona; Erol Veznedaroglu; Frank R Hellinger; Lei Feng; Jawad F Kirmani; Demetrius K Lopes; Brian T Jankowitz; Michael R Frankel; Vincent Costalat; Nirav A Vora; Albert J Yoo; Amer M Malik; Anthony J Furlan; Marta Rubiera; Amin Aghaebrahim; Jean-Marc Olivot; Wondwossen G Tekle; Ryan Shields; Todd Graves; Roger J Lewis; Wade S Smith; David S Liebeskind; Jeffrey L Saver; Tudor G Jovin Journal: N Engl J Med Date: 2017-11-11 Impact factor: 91.245
Authors: Mayank Goyal; Bijoy K Menon; Wim H van Zwam; Diederik W J Dippel; Peter J Mitchell; Andrew M Demchuk; Antoni Dávalos; Charles B L M Majoie; Aad van der Lugt; Maria A de Miquel; Geoffrey A Donnan; Yvo B W E M Roos; Alain Bonafe; Reza Jahan; Hans-Christoph Diener; Lucie A van den Berg; Elad I Levy; Olvert A Berkhemer; Vitor M Pereira; Jeremy Rempel; Mònica Millán; Stephen M Davis; Daniel Roy; John Thornton; Luis San Román; Marc Ribó; Debbie Beumer; Bruce Stouch; Scott Brown; Bruce C V Campbell; Robert J van Oostenbrugge; Jeffrey L Saver; Michael D Hill; Tudor G Jovin Journal: Lancet Date: 2016-02-18 Impact factor: 79.321
Authors: Ji Won Kim; Pyoung Jeon; Gyeong-Moon Kim; Oh Young Bang; Hong Sik Byun; Keon Ha Kim Journal: Clin Neurol Neurosurg Date: 2012-05-23 Impact factor: 1.876
Authors: Olvert A Berkhemer; Puck S S Fransen; Debbie Beumer; Lucie A van den Berg; Hester F Lingsma; Albert J Yoo; Wouter J Schonewille; Jan Albert Vos; Paul J Nederkoorn; Marieke J H Wermer; Marianne A A van Walderveen; Julie Staals; Jeannette Hofmeijer; Jacques A van Oostayen; Geert J Lycklama à Nijeholt; Jelis Boiten; Patrick A Brouwer; Bart J Emmer; Sebastiaan F de Bruijn; Lukas C van Dijk; L Jaap Kappelle; Rob H Lo; Ewoud J van Dijk; Joost de Vries; Paul L M de Kort; Willem Jan J van Rooij; Jan S P van den Berg; Boudewijn A A M van Hasselt; Leo A M Aerden; René J Dallinga; Marieke C Visser; Joseph C J Bot; Patrick C Vroomen; Omid Eshghi; Tobien H C M L Schreuder; Roel J J Heijboer; Koos Keizer; Alexander V Tielbeek; Heleen M den Hertog; Dick G Gerrits; Renske M van den Berg-Vos; Giorgos B Karas; Ewout W Steyerberg; H Zwenneke Flach; Henk A Marquering; Marieke E S Sprengers; Sjoerd F M Jenniskens; Ludo F M Beenen; René van den Berg; Peter J Koudstaal; Wim H van Zwam; Yvo B W E M Roos; Aad van der Lugt; Robert J van Oostenbrugge; Charles B L M Majoie; Diederik W J Dippel Journal: N Engl J Med Date: 2014-12-17 Impact factor: 91.245