Pereira da Silva Anderson Matheus, Ribeiro Gonçalves Ocílio, Han Mariana Lee, Ribeiro Filipe Virgilio, Falcão Luciano, Ohannesian Victor Arthur, de Bastos Maximiano Mariana Letícia, Fukunaga Christian Ken, Carretta Lucca Tamara Alves, Suruagy-Motta Ricardo Fonseca Oliveira, Ferreira Christian
Department of Physiology and pharmacology, Federal University of Pernambuco, Recife, PE, Brazil.
Department of Medicine, Federal University of Piauí, Teresina, PI, Brazil.
Clin Neuroradiol. 2025 Aug 18. doi: 10.1007/s00062-025-01552-1.
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.
analysis to evaluate the efficacy and safety of prophylactic tirofiban administration in patients undergoing eCAS without prior DAPT.
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.
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%).
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.
急诊颈动脉支架置入术（eCAS）常用于急性缺血性卒中，以恢复重度颈动脉狭窄或夹层患者的脑灌注。在未进行过双联抗血小板治疗（DAPT）的情况下，这些手术会增加急性支架内血栓形成的风险。替罗非班是一种起效迅速的静脉注射糖蛋白IIb/IIIa抑制剂，已被提议作为一种桥接抗血小板策略，但其在神经血管领域的疗效和安全性仍不确定。
分析评估在未进行过DAPT的接受eCAS治疗的患者中预防性使用替罗非班的疗效和安全性。
根据PRISMA指南进行系统评价和荟萃分析。纳入比较接受eCAS治疗的患者静脉注射替罗非班与对照组（未使用替罗非班或使用替代药物）的研究。使用随机效应模型计算风险比（RR）。
纳入四项研究，共649例患者。使用替罗非班与急性支架内血栓形成发生率较低相关（RR 0.21；95%CI 0.09 - 0.49；I=0%）。在替罗非班组和对照组之间，关于症状性颅内出血（RR 0.45；95%CI 0.13 - 1.52；I=41.4%）、无症状性颅内出血（RR 1.28；95%CI 0.64 - 2.59；I=13.4%）或全因死亡率（RR 0.72；95%CI 0.41 - 1.26；I=34.7%）未发现显著差异。
替罗非班似乎可降低eCAS术后急性支架内血栓形成的风险，且不增加出血并发症或死亡率。需要进一步的随机试验来验证这些发现并确定最佳的围手术期抗血小板策略。
