Yue Chengsong, Liu Xiang, Guo Changwei, Wang Lilan, Zhao Wenlong, Sun Wenzhe, Song Jiaxing, Yang Jie, Li Linyu, Yu Nizhen, Yang Shihai, Shi Xiaolei, Huang Jiacheng, Kong Weiling, Li Zhenqiang, Yang Shunyu, Yang Shuang, Zi Wenjie, Lin Yi, Li Fengli
Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China.
Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
Eur J Neurol. 2025 Jan;32(1):e70034. doi: 10.1111/ene.70034.
Despite achieving ideal reperfusion (eTICI = 3) through endovascular treatment (EVT), some acute ischemic stroke (AIS) patients still experience poor outcomes. This study aims to evaluate the efficacy and safety of tirofiban in AIS patients with ideal reperfusion, focusing on its effects in large artery atherosclerosis (LAA) and cardioembolic (CE) stroke.
A total of 474 AIS patients from the RESCUE-BT database were included. Patients were assigned to either the tirofiban or placebo group based on the treatment received. The primary outcome was favorable functional recovery at 90 days (mRS ≤2), and safety outcomes included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Multivariable logistic regression was used to adjust for confounders, and subgroup and interaction analyses assessed tirofiban's efficacy in LAA and CE populations.
In the overall population that achieved ideal reperfusion, Tirofiban did not improve clinical outcomes and did not increase the risk of mortality or incidence of sICH (p > 0.05). However, subgroup analysis indicated potential clinical benefits for patients with higher NIHSS scores in the LAA group, especially in the subgroup with NIHSS scores >13 (adjusted OR 4.671, 95% CI [1.545, 14.122]). No significant differences were found in the CE group.
Tirofiban showed potential benefits for LAA patients with ideal reperfusion, especially those with NIHSS scores above 13. Careful patient selection is recommended.
尽管通过血管内治疗（EVT）实现了理想再灌注（eTICI = 3），但一些急性缺血性卒中（AIS）患者的预后仍然较差。本研究旨在评估替罗非班在实现理想再灌注的AIS患者中的疗效和安全性，重点关注其在大动脉粥样硬化（LAA）和心源性栓塞（CE）性卒中中的作用。
纳入了RESCUE - BT数据库中的474例AIS患者。根据接受的治疗将患者分为替罗非班组或安慰剂组。主要结局是90天时功能恢复良好（改良Rankin量表[mRS]≤2），安全性结局包括症状性颅内出血（sICH）和90天死亡率。采用多变量逻辑回归调整混杂因素，亚组分析和交互分析评估替罗非班在LAA和CE人群中的疗效。
在实现理想再灌注的总体人群中，替罗非班未改善临床结局，也未增加死亡风险或sICH发生率（p > 0.05）。然而，亚组分析表明，LAA组中NIHSS评分较高的患者可能有临床获益，尤其是在NIHSS评分>13的亚组中（调整后的比值比为4.671，95%置信区间[1.545, 14.122]）。CE组未发现显著差异。
替罗非班对实现理想再灌注的LAA患者显示出潜在益处，尤其是NIHSS评分高于13的患者。建议谨慎选择患者。
