替罗非班治疗急性颅内动脉粥样硬化性狭窄相关闭塞患者的疗效及安全性：血管内治疗后残余狭窄
Efficacy and Safety of Low-Dose Tirofiban for Acute Intracranial Atherosclerotic Stenosis Related Occlusion with Residual Stenosis after Endovascular Treatment.
机构信息
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.
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.
出版信息
J Stroke Cerebrovasc Dis. 2020 Apr;29(4):104619. doi: 10.1016/j.jstrokecerebrovasdis.2019.104619. Epub 2020 Jan 22.
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.
背景
急性颅内动脉粥样硬化性狭窄相关闭塞（ICAS-O）血管内治疗（EVT）后残余狭窄患者的最佳治疗策略尚不清楚。本研究旨在评估低剂量替罗非班在 EVT 治疗后急性 ICAS-O 所致残余狭窄患者中的疗效和安全性。
方法
回顾性分析 2015 年 3 月至 2019 年 5 月连续接受 EVT 治疗的急性 ICAS-O 后残余狭窄患者。患者分为单纯 EVT 组或 EVT+替罗非班组。主要终点为 90 天时改良 Rankin 量表评分 0-2 的良好功能结局。次要终点为 EVT 后 72 小时内再通动脉的闭塞率、症状性颅内出血（sICH）、任何颅内出血（ICH）和 90 天时的死亡率。采用 logistic 回归分析再闭塞和功能结局的预测因素。
结果
共纳入 98 例患者，其中 50 例接受替罗非班治疗，48 例未接受替罗非班治疗。与单纯 EVT 组患者相比，EVT+替罗非班组患者的良好功能结局率更高、死亡率更低、再闭塞率更低（56.3%比 30.4%，P=0.014；8.3%比 28.3%，P=0.016；10.4%比 32.6%，P=0.011）。两组任何 ICH 和 sICH 发生率相似。替罗非班的使用与良好的功能结局相关（优势比[OR]，3.417；95%置信区间[CI]，1.149-10.163；P=0.027），再闭塞率降低（OR，0.145；95%CI，0.038-0.546；P=0.004）。
结论
在急性 ICAS-O 血管内治疗后残余狭窄患者中，低剂量替罗非班可改善功能结局，降低再闭塞发生率，且不增加任何 ICH 和 sICH。
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