Ribeiro Luiz Fábio Silva, de Freitas Lucas Rezende, Udoma-Udofa Ofonime Chantal, Monteiro Júlia Dos Santos, Silva Yasmin Picanço, Fagundes Walter
Federal University of São João del-Rei, Chanadour, Divinópolis, Brazil.
Federal University of Juiz de Fora, Juiz de Fora, Brazil.
Neuroradiology. 2025 Jan;67(1):241-255. doi: 10.1007/s00234-024-03537-2. Epub 2024 Dec 30.
Tirofiban has emerged as an adjunct therapy for acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). However, its benefits for AIS patients with intracranial atherosclerotic disease (ICAD) remains unclear. This meta-analysis evaluates its efficacy and safety in ICAD-related AIS patients undergoing EVT.
We searched PubMed, Cochrane, and Embase up to September, 2024, for studies comparing tirofiban to placebo or no intervention in ICAD-related AIS. Primary outcome was modified Rankin Scale (mRS) 0-2 at 90 days. Secondary outcomes included 90-day mRS 0-1, mRS score at 90 days, successful reperfusion, 90-day mortality, postprocedural reocclusion, and symptomatic/non-symptomatic intracranial hemorrhage (ICH). Subgroup analyses evaluated tirofiban administration routes (intravenous, intra-arterial, or combined).
Thirteen studies comprising 3,572 patients were included. Intravenous tirofiban significantly increased mRS 0-2 (RR 1.26 [95% CI 1.13; 1.42]; p < 0.0001, I²= 0%), mRS 0-1(RR 1.24 [95% CI 1.05; 1.45]; p = 0.0098, I² = 0%), reduced mRS score by 0.58 points ([95% CI -0.99; -0.17]; p = 0.006, I²= 66%) and decreased mortality (RR 0.68 [95% CI 0.57; 0.80]; p < 0.0001, I²= 8%) at 90 days compared to control. Tirofiban overall reduced postprocedural reocclusion relative to control (RR 0.36 [95% CI 0.14; 0.94]; p = 0.036, I²= 73%). No significant differences were observed in successful reperfusion or ICH.
Intravenous tirofiban demonstrated an efficacy and safety profile, improving functional recovery and reducing mortality. Tirofiban overall reduced postprocedural reocclusion compared to control. No significant differences were found between groups in successful reperfusion or ICH. These findings support tirofiban as a safe and effective EVT adjunct.
PROSPERO (CRD42024606522).
替罗非班已成为接受血管内治疗（EVT）的急性缺血性卒中（AIS）患者的辅助治疗方法。然而，其对颅内动脉粥样硬化疾病（ICAD）相关AIS患者的益处仍不明确。本荟萃分析评估其在接受EVT的ICAD相关AIS患者中的疗效和安全性。
我们检索了截至2024年9月的PubMed、Cochrane和Embase数据库，以查找比较替罗非班与安慰剂或不进行干预在ICAD相关AIS中的研究。主要结局是90天时改良Rankin量表（mRS）评分为0 - 2分。次要结局包括90天时mRS评分为0 - 1分、90天时的mRS评分、成功再灌注、90天死亡率、术后再闭塞以及有症状/无症状颅内出血（ICH）。亚组分析评估了替罗非班的给药途径（静脉内、动脉内或联合）。
纳入了13项研究，共3572例患者。与对照组相比，静脉注射替罗非班显著提高了90天时mRS评分为0 - 2分的比例（RR 1.26 [95% CI 1.13; 1.42]；p < 0.0001，I² = 0%）、mRS评分为0 - 1分的比例（RR 1.24 [95% CI 1.05; 1.45]；p = 0.0098，I² = 0%），mRS评分降低了0.58分（[95% CI -0.99; -0.17]；p = 0.006，I² = 66%），并降低了死亡率（RR 0.68 [95% CI 0.57; 0.80]；p < 0.0001，I² = 8%）。与对照组相比，替罗非班总体上降低了术后再闭塞率（RR 0.36 [95% CI 0.14; 0.94]；p = 0.036，I² = 73%）。在成功再灌注或ICH方面未观察到显著差异。
静脉注射替罗非班显示出疗效和安全性，可改善功能恢复并降低死亡率。与对照组相比，替罗非班总体上降低了术后再闭塞率。在成功再灌注或ICH方面，各组之间未发现显著差异。这些发现支持替罗非班作为一种安全有效的EVT辅助药物。
PROSPERO（CRD42024606522）。
