Yang M, Huo X, Gao F, Wang A, Ma N, Shi H, Chen W, Wang S, Wang Y, Miao Z
Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Beijing Tiantan Hospital, Beijing, China.
Eur J Neurol. 2020 Jun;27(6):1056-1061. doi: 10.1111/ene.14170. Epub 2020 Mar 17.
Tirofiban administration during mechanical thrombectomy (MT) remains controversial. The aim was to evaluate the safety and efficacy of a low-dose rescue tirofiban regimen during MT for Chinese acute ischaemic stroke (AIS) patients.
Patients from the ANGEL study, a multicentric, prospective registry study that included AIS patients who underwent MT owing to proximal large-artery occlusion from June 2015 to December 2017, were collected. The patients were dichotomized into tirofiban and non-tirofiban groups according to whether rescue tirofiban was performed during MT. Safety outcomes [symptomatic intracerebral haemorrhage (sICH), total intracerebral haemorrhage (ICH) and distal embolization] and efficacy outcomes (artery recanalization and functional outcomes at 3-month follow-up) were compared between groups using logistic regression analysis.
A total of 662 patients were included in this study, and 230 (34.7%) were in the tirofiban group. No significant differences in safety outcomes on sICH, total ICH and distal embolization and efficacy outcomes on artery recanalization and 3-month functional independence were observed between the tirofiban and non-tirofiban group in the entire cohort or the anterior circulation stroke or posterior circulation stroke patients (P > 0.05 for all groups). However, low-dose rescue tirofiban was significantly correlated with 3-month mortality reduction for posterior circulation stroke patients [adjusted hazard ratio 0.35 (0.14-0.92), P = 0.03].
Low-dose rescue tirofiban during MT was not associated with increased risk of sICH, ICH and distal embolization for AIS patients, and may be correlated with 3-month mortality reduction for posterior circulation stroke.
在机械取栓（MT）过程中使用替罗非班仍存在争议。本研究旨在评估低剂量挽救性替罗非班方案用于中国急性缺血性卒中（AIS）患者MT治疗的安全性和有效性。
收集自2015年6月至2017年12月期间因近端大动脉闭塞接受MT治疗的AIS患者，这些患者来自多中心前瞻性登记研究ANGEL研究。根据MT过程中是否使用挽救性替罗非班，将患者分为替罗非班组和非替罗非班组。采用逻辑回归分析比较两组的安全性结局[症状性颅内出血（sICH）、颅内出血总量（ICH）和远端栓塞]和有效性结局（动脉再通和3个月随访时的功能结局）。
本研究共纳入662例患者，其中230例（34.7%）为替罗非班组。在整个队列、前循环卒中或后循环卒中患者中，替罗非班组和非替罗非班组在sICH、ICH总量和远端栓塞等安全性结局以及动脉再通和3个月功能独立性等有效性结局方面均未观察到显著差异（所有组P>0.05）。然而，低剂量挽救性替罗非班与后循环卒中患者3个月死亡率降低显著相关[调整后风险比0.35（0.14 - 0.92），P = 0.03]。
MT期间低剂量挽救性替罗非班与AIS患者sICH、ICH和远端栓塞风险增加无关，且可能与后循环卒中患者3个月死亡率降低相关。
