机械取栓治疗急性缺血性脑卒中伴大血管闭塞（LVO）患者成功再通后，联用替罗非班的安全性和有效性。
Safety and efficacy of adjunct tirofiban treatment following mechanical thrombectomy for acute ischemic stroke patients with large vessel occlusion (LVO) resulting in successful reperfusion.
机构信息
Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
出版信息
Interv Neuroradiol. 2024 Oct;30(5):657-662. doi: 10.1177/15910199221138883. Epub 2022 Nov 10.
BACKGROUND AND PURPOSE
Tirofiban administration after mechanical thrombectomy (MT) remains controversial. This study aimed to investigate the efficacy and safety of adjunct tirofiban treatment following MT for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) that resulted in successful reperfusion on digital subtraction angiography (DSA).
METHODS
This retrospective study was conducted in Zhengzhou University University People's Hospital, an advanced stroke center in China. Consecutive patients with AIS who underwent endovascular therapy (EVT) were enrolled from June 2018 to January 2022. The safety endpoints were symptomatic intracerebral hemorrhage (sICH), total intracranial hemorrhage (ICH), and 3-month mortality. The efficacy endpoints were 3-month modified Rankin scale (mRS) score and 24-h neurological improvement.
RESULTS
A total of 145 consecutive patients with AIS who underwent MT were analyzed, of whom 51 (35.2%) patients were in the tirofiban group. There were 30 (20.7%) patients with sICH, 50 (34.5%) patients suffered from ICH within 24-h post-MT, and 47 (32.4%) dead at 3-month. Besides, 31 (21.4%) patients achieved excellent clinical outcomes (mRS, 0-1), and 24-h neurological improvement was found in 29 (20.0%) patients. No statistically significant differences were found in safety outcomes on sICH, total ICH, and 3-month mortality, as well as efficacy outcomes on 3-month mRS scores (0-1) and 24-h neurological improvement between the two groups ( > 0.05 for all). Additionally, tirofiban was associated with 3-month mRS scores of 0-2 (adjusted odds ratio (OR), 3.75; 95% confidence interval (CI), 1.41-10.02, = 0.008).
CONCLUSION
Adjunct tirofiban treatment following MT for AIS patients with LVO that resulted in successful reperfusion on DSA was not correlated with the increased risk of safety endpoints on sICH, ICH, and 3-month mortality, and it may be associated with a lower 3-month mRS score.
背景与目的
机械血栓切除术后（MT）给予替罗非班的治疗仍存在争议。本研究旨在探讨替罗非班辅助治疗对接受血管内治疗（EVT）的急性缺血性卒中（AIS）伴大血管闭塞（LVO）患者的疗效和安全性，这些患者的数字减影血管造影（DSA）显示再通成功。
方法
这是一项在中国先进卒中中心——郑州大学人民医院进行的回顾性研究。连续纳入 2018 年 6 月至 2022 年 1 月接受 EVT 的 AIS 患者。安全性终点为症状性颅内出血（sICH）、总颅内出血（ICH）和 3 个月死亡率。有效性终点为 3 个月改良 Rankin 量表（mRS）评分和 24 小时神经功能改善。
结果
共分析了 145 例接受 MT 的 AIS 连续患者，其中替罗非班组 51 例（35.2%）。30 例（20.7%）发生 sICH，50 例（34.5%）患者在 MT 后 24 小时内发生 ICH，47 例（32.4%）患者在 3 个月时死亡。此外，31 例（21.4%）患者获得了良好的临床结局（mRS，0-1），29 例（20.0%）患者在 24 小时时神经功能改善。两组间 sICH、总 ICH 和 3 个月死亡率以及 3 个月 mRS 评分（0-1）和 24 小时神经功能改善等安全性结局以及有效性结局差异均无统计学意义（所有 P 值均>0.05）。此外，替罗非班与 3 个月 mRS 评分 0-2 相关（校正优势比（OR）3.75，95%置信区间（CI）1.41-10.02，P=0.008）。
结论
DSA 显示再通成功的 LVO AIS 患者，在 MT 后给予替罗非班治疗与增加 sICH、ICH 和 3 个月死亡率的安全性终点无关，且可能与较低的 3 个月 mRS 评分相关。
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