Huo Xiaochuan, Wang Anxin, Mo Dapeng, Gao Feng, Ma Ning, Wang Yilong, Wang Yongjun, Miao Zhongrong
Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2021 Feb 11;12:630301. doi: 10.3389/fneur.2021.630301. eCollection 2021.
To investigate the safety and efficacy of tirofiban in acute ischemic stroke (AIS) patients with large artery atherosclerosis (LAA) stroke etiology receiving endovascular therapy (EVT). In this multi-center prospective study, patients who were considered to have an indication received a low dose intra-arterial bolus (0.25-1 mg) of tirofiban. The safety and efficacy outcomes at 90-day follow-ups included symptomatic intracranial hemorrhage (sICH), recanalization rate, functional outcome, and mortality. Among the 649 AIS patients with LAA, those in the tirofiban group ( = 244) showed higher systolic blood pressure (BP) and NIHSS score on admission, puncture-to-recanalization time, lower frequency of intravenous thrombolysis and intra-arterial thrombolysis, higher frequency of antiplatelet, heparinization, mechanical stent retrieval, aspiration, balloon angioplasty, and more retrieval times compared with those in the non-tirofiban group ( = 405) (all < ). Tirofiban was found to be associated with superior clinical outcomes in anterior circulation stroke and major stroke patients [adjusted odds ratio (OR) = 2.163, 95% confidence interval (CI) = 1.130-4.140, = and adjusted OR = 2.361, 95% CI = 1.326-4.202, = , respectively] and a lower risk of mortality at 90-day follow-ups (adjusted OR = 0.159, 95% CI = 0.042-0.599, = and adjusted OR = 0.252, 95% CI = 0.103-0.621, = , respectively). There was no significant difference in sICH between the two groups. Tirofiban in AIS patients with LAA undergoing EVT is safe and may benefit the functional outcomes in anterior circulation and major stroke patients and showed a trend for reduced mortality.
探讨替罗非班在接受血管内治疗（EVT）的大动脉粥样硬化（LAA）性病因急性缺血性卒中（AIS）患者中的安全性和有效性。在这项多中心前瞻性研究中，被认为有适应证的患者接受低剂量动脉内推注（0.25 - 1毫克）替罗非班。90天随访时的安全性和有效性结局包括症状性颅内出血（sICH）、再通率、功能结局和死亡率。在649例LAA性AIS患者中，替罗非班组（n = 244）与非替罗非班组（n = 405）相比，入院时收缩压（BP）和美国国立卫生研究院卒中量表（NIHSS）评分更高，穿刺至再通时间更长，静脉溶栓和动脉内溶栓频率更低，抗血小板、肝素化、机械取栓、抽吸、球囊血管成形术频率更高，取栓次数更多（均P < ）。发现替罗非班与前循环卒中及大面积卒中患者的更好临床结局相关[校正比值比（OR）= 2.163，95%置信区间（CI）= 1.130 - 4.140，P = 及校正OR = 2.361，95% CI = 1.326 - 4.202，P = ，分别]，且90天随访时死亡风险更低（校正OR = 0.159，95% CI = 0.042 - 0.599，P = 及校正OR = 0.252，95% CI = 0.103 - 0.621，P = ，分别）。两组间sICH无显著差异。接受EVT的LAA性AIS患者使用替罗非班是安全的，可能使前循环和大面积卒中患者的功能结局受益，并显示出降低死亡率的趋势。
