Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Institute of Integrative Medicine, Qingdao Medical College, Qingdao University, Qingdao, China.
Clin Transl Sci. 2024 Jan;17(1):e13686. doi: 10.1111/cts.13686. Epub 2023 Dec 1.
In a previously published clinical trial, we demonstrated that tirofiban was effective and safe in acute ischemic stroke (AIS) patients who did not undergo early recanalization treatments. We aimed to evaluate neuroimaging characteristics and their clinical significance to guide tirofiban treatment. In this post hoc analysis, location of infarcts (anterior circulation stroke [ACS] vs. posterior circulation stroke [PCS]), degree of cerebral artery stenosis (≤69% vs. ≥70% or occlusion), total infarct volume, and ASPECTS were used to predict the treatment effects of tirofiban, defined as the proportions of excellent and favorable functional outcome (modified Rankin Scale [mRS] score of 0-1, 0-2) at 90 days. ACS patients were more likely to achieve excellent (OR 2.08; 95% CI 1.25-3.45; p = 0.004) and favorable functional outcome (OR 2.28; 95% CI 1.24-4.22; p = 0.008) when treated with tirofiban. However, there was no significant difference in PCS patients between tirofiban and the control group. For patients with severe stenosis (≥70% or occlusion), tirofiban treatment improved the proportion of good outcomes (OR 2.84; 95% CI 1.44-5.60; p = 0.002 for mRS 0-1; OR 2.42; 95% CI 1.22-4.77; p = 0.011 for mRS 0-2). Meanwhile, we found that tirofiban improved outcome in patients with ASPECTS 8-10 and was independent of total infarct volume. These findings support the hypothesis that patients with ACS and severe stenosis may be recommended for tirofiban treatment, which can be predicted independent of total infarct volume.
在之前发表的一项临床试验中，我们证明替罗非班对未接受早期再通治疗的急性缺血性脑卒中（AIS）患者是有效且安全的。我们旨在评估神经影像学特征及其临床意义，以指导替罗非班的治疗。在本事后分析中，梗死部位（前循环卒中 [ACS] 与后循环卒中 [PCS]）、脑动脉狭窄程度（≤69%与≥70%或闭塞）、总梗死体积和 ASPECTS 用于预测替罗非班的治疗效果，定义为 90 天时改良 Rankin 量表（mRS）评分 0-1、0-2 的优秀和良好功能结局比例。ACS 患者接受替罗非班治疗更有可能获得良好的（OR 2.08；95%CI 1.25-3.45；p=0.004）和有利的功能结局（OR 2.28；95%CI 1.24-4.22；p=0.008）。然而，PCS 患者中替罗非班与对照组之间无显著差异。对于严重狭窄（≥70%或闭塞）患者，替罗非班治疗改善了良好结局的比例（mRS 0-1 的 OR 2.84；95%CI 1.44-5.60；p=0.002；mRS 0-2 的 OR 2.42；95%CI 1.22-4.77；p=0.011）。同时，我们发现替罗非班改善了 ASPECTS 8-10 患者的结局，且与总梗死体积无关。这些发现支持了这样一种假设，即 ACS 和严重狭窄的患者可能被推荐接受替罗非班治疗，这种治疗效果可以独立于总梗死体积来预测。
