Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China.
Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Eur J Neurol. 2024 Oct;31(10):e16419. doi: 10.1111/ene.16419. Epub 2024 Jul 29.
The aim of this study is to investigate the efficacy and safety of preoperative versus intraoperative tirofiban in patients with large vessel occlusion (LVO) due to large artery atherosclerosis (LAA).
This is a retrospective multicenter cohort study based on the RESCUE-RE (Registration Study for Critical Care of Acute Ischemic Stroke After Recanalization) trial enrolling patients with anterior circulation LVO classified as LAA within 24 h of onset. Patients were divided into three groups: preoperative tirofiban (PT), intraoperative tirofiban (IT), and no tirofiban (NT). Propensity score matching (PSM) was used to balance baseline characteristics. The efficacy outcomes included 90-day functional independence (modified Rankin Scale score = 0-2) and early partial recanalization (EPR; defined as a modified Thrombolysis in Cerebral Infarction score = 1-2a). The safety outcomes included symptomatic intracranial hemorrhage (sICH).
A total of 104 matched triplets were obtained through PSM. Compared with NT, PT increased 90-day functional independence (60.8% vs. 42.3%, p = 0.008) and EPR (42.7% vs. 18.3%, p < 0.001) rate, with a tendency to increase the asymptomatic intracranial hemorrhage (aICH) proportion (28.8% vs. 18.3%, p = 0.072). Compared with IT, PT had a higher 90-day functional independence (60.8% vs. 45.2%, p = 0.025) and EPR (42.7% vs. 20.2%, p = 0.001) rate, with no significant difference in sICH (14.4% vs. 7.7%, p = 0.122) and aICH (28.8% vs. 21.2%, p = 0.200). Compared with NT, IT had a lower 90-day mortality rate (9.6% vs. 24.0%, p = 0.005).
Tirofiban shows good adjuvant therapy potential in acute ischemic stroke-LVO due to LAA patients. PT is associated with higher rates of EPR and better therapeutic efficacy. In addition, EPR may be a potential way to improve prognosis.
本研究旨在探讨在大动脉粥样硬化（LAA）导致的大血管闭塞（LVO）患者中，术前与术中替罗非班的疗效和安全性。
这是一项基于 RESCUE-RE（急性缺血性脑卒中再通后关键护理的登记研究）试验的回顾性多中心队列研究，纳入了发病 24 小时内前循环 LVO 且分类为 LAA 的患者。患者分为三组：术前替罗非班组（PT）、术中替罗非班组（IT）和无替罗非班组（NT）。采用倾向评分匹配（PSM）来平衡基线特征。疗效结局包括 90 天功能独立性（改良 Rankin 量表评分=0-2）和早期部分再通（EPR；定义为改良脑梗死溶栓评分=1-2a）。安全性结局包括症状性颅内出血（sICH）。
通过 PSM 共获得 104 对匹配的三联体。与 NT 相比，PT 增加了 90 天功能独立性（60.8%比 42.3%，p=0.008）和 EPR（42.7%比 18.3%，p<0.001）的比例，并有增加无症状性颅内出血（aICH）比例的趋势（28.8%比 18.3%，p=0.072）。与 IT 相比，PT 具有更高的 90 天功能独立性（60.8%比 45.2%，p=0.025）和 EPR（42.7%比 20.2%，p=0.001）的比例，sICH（14.4%比 7.7%，p=0.122）和 aICH（28.8%比 21.2%，p=0.200）的比例无显著差异。与 NT 相比，IT 具有更低的 90 天死亡率（9.6%比 24.0%，p=0.005）。
替罗非班在大动脉粥样硬化性 LVO 导致的急性缺血性脑卒中患者中具有良好的辅助治疗潜力。PT 与更高的 EPR 率和更好的治疗效果相关。此外，EPR 可能是改善预后的一种潜在方法。
