Intravenous Tirofiban for Preventing Acute In-Stent Thrombosis in Emergent Carotid Artery Stenting: a Systematic Review and Meta-Analysis.

INTRODUCTION

Emergent carotid artery stenting (eCAS) is frequently performed in acute ischemic stroke to restore cerebral perfusion in patients with high-grade carotid stenosis or dissection. In the absence of prior dual antiplatelet therapy (DAPT), these procedures carry a heightened risk of acute in-stent thrombosis. Tirofiban, an intravenous glycoprotein IIb/IIIa inhibitor with rapid onset of action, has been proposed as a bridging antiplatelet strategy, although its efficacy and safety in the neurovascular setting remain uncertain.

OBJECTIVE

analysis to evaluate the efficacy and safety of prophylactic tirofiban administration in patients undergoing eCAS without prior DAPT.

METHODS

A systematic review and meta-analysis were conducted according to PRISMA guidelines. Studies comparing intravenous tirofiban to control (no tirofiban or alternative agents) in patients undergoing eCAS were included. Risk ratios (RR) were calculated using a random-effects model.

RESULTS

Four studies comprising 649 patients were included. Tirofiban use was associated with a lower incidence of acute in-stent thrombosis (RR 0.21; 95% CI 0.09-0.49; I = 0%). No significant differences were found between tirofiban and control groups regarding sICH (RR 0.45; 95% CI 0.13-1.52; I = 41.4%), aICH (RR 1.28; 95% CI 0.64-2.59; I = 13.4%), or all-cause mortality (RR 0.72; 95% CI 0.41-1.26; I = 34.7%).

CONCLUSION

Tirofiban appears to reduce the risk of acute in-stent thrombosis after eCAS without increasing the incidence of hemorrhagic complications or mortality. Further randomized trials are needed to validate these findings and define optimal periprocedural antiplatelet strategies.