1Department of Neurology of Drum Tower Hospital, Medical School and the State Key Laboratory of Pharmaceutical Biotechnology, Nanjing University, Nanjing.
5Nanjing Neurology Clinic Medical Center, Nanjing.
Neurosurg Focus. 2023 Oct;55(4):E21. doi: 10.3171/2023.7.FOCUS23150.
Although tirofiban and endovascular thrombectomy have been widely used in the treatment of acute ischemic stroke (AIS) patients, the effectiveness of their combined application remains a subject of debate. This study aimed to assess the efficacy and safety of tirofiban in direct thrombectomy for AIS with anterior circulation vessel occlusion.
A total of 204 patients undergoing direct thrombectomy between January 2020 and December 2021 for AIS with anterior circulation vessel occlusion from four hospitals were included in this study. Patients at high risk of reocclusion with severe atherosclerosis, those who achieved successful recanalization for ≥ 3 stent retriever passes, or those who underwent emergency stenting or balloon angioplasty for severe residual stenosis were treated with tirofiban. Following a low-dose intra-arterial bolus (0.25-1 mg) immediately after endovascular treatment, tirofiban was administered continuously through intravenous infusion (0.1 μg/kg/min) for 12-24 hours. The primary efficacy outcome was evaluated using the 90-day modified Rankin Scale score. The safety outcome was assessed using symptomatic intracerebral hemorrhage (sICH) and mortality rates.
The tirofiban group and nontirofiban group each included 102 patients. The favorable outcome rate in the tirofiban group was significantly higher than that in the nontirofiban group (53.9% vs 35.3%, p = 0.007). However, the sICH and 90-day mortality rates were lower in the tirofiban group, despite a lack of statistical significance (sICH: 15.7% vs 16.7%, p = 0.849; 90-day mortality: 16.67% vs 24.51%, p = 0.166). Finally, it was found that older patients (> 72 years), male patients, patients with admission National Institutes of Health Stroke Scale scores > 14, patients with a time from onset to reperfusion > 327 minutes, and patients with a medical history of diabetes tend to benefit from tirofiban treatment.
This study suggests that tirofiban combined with direct thrombectomy improves functional outcomes of AIS and reduces the 90-day mortality rate. Therefore, it could be considered as a suitable treatment option for AIS patients with anterior circulation vessel occlusion.
替罗非班和血管内血栓切除术已广泛应用于急性缺血性脑卒中（AIS）患者的治疗，但两者联合应用的疗效仍存在争议。本研究旨在评估替罗非班在伴有前循环血管闭塞的 AIS 直接血栓切除术中的疗效和安全性。
本研究纳入了 204 例 2020 年 1 月至 2021 年 12 月期间在 4 家医院接受直接血栓切除术治疗伴有前循环血管闭塞的 AIS 患者。对于有严重动脉粥样硬化导致再闭塞高风险、支架取栓 3 次以上达到成功再通、或因严重残余狭窄而行紧急支架或球囊血管成形术的患者，给予替罗非班治疗。血管内治疗后立即给予低剂量动脉内推注（0.25-1mg），随后通过静脉输注（0.1μg/kg/min）持续输注替罗非班 12-24 小时。采用 90 天改良 Rankin 量表评分评估主要疗效结局，采用症状性颅内出血（sICH）和死亡率评估安全性结局。
替罗非班组和非替罗非班组各纳入 102 例患者。替罗非班组的良好预后率明显高于非替罗非班组（53.9%比 35.3%，p=0.007）。然而，替罗非班组的 sICH 和 90 天死亡率虽有所降低，但无统计学意义（sICH：15.7%比 16.7%，p=0.849；90 天死亡率：16.67%比 24.51%，p=0.166）。最后发现，年龄＞72 岁、男性、入院美国国立卫生研究院卒中量表（NIHSS）评分＞14 分、发病至再灌注时间＞327 分钟、有糖尿病病史的患者更受益于替罗非班治疗。
本研究表明，替罗非班联合直接血栓切除术可改善 AIS 的功能结局并降低 90 天死亡率，因此可能成为伴有前循环血管闭塞的 AIS 患者的一种合适治疗选择。
