In patients with non-atherosclerotic acute basilar artery occlusion, tirofiban was associated with higher 90-day favorable functional outcomes (aOR 2.06; 95% CI 1.21-3.54; P=0.009).
Cohort (n=221)
Does adjunctive tirofiban improve 90-day favorable function in patients with acute basilar artery occlusion undergoing endovascular treatment?
Adjunctive tirofiban may improve functional outcomes in non-atherosclerotic acute basilar artery occlusion undergoing endovascular treatment, but confers no clear benefit in atherosclerotic cases.
Odds Ratio: 2.06 (95% CI 1.21–3.54)
p-value: p=0.009
Background and purpose Acute basilar artery occlusion (BAO) is a lethal neurovascular emergency where endovascular treatment (EVT) is limited by futile reperfusion. Tirofiban’s adjunctive use in BAO yields inconsistent findings, likely due to unaddressed etiological heterogeneity—relevant in Asian populations with high atherosclerotic (AS) prevalence but substantial non-AS subgroups. This pre-specified post hoc ATTENTION trial analysis explored potential etiology-specific associations between tirofiban and BAO-EVT outcomes. Methods We included 221 patients with BAO who underwent EVT in the ATTENTION trial ( NCT04751708 ). Stroke etiology was categorized into AS and non-AS subgroups per the TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. Inverse probability of treatment weighting (IPTW) balanced baseline covariates (standardized mean difference <0.2), with doubly robust estimation to mitigate bias. Primary outcome was 90-day favorable function (modified Rankin Scale (mRS) 0–3). Safety outcomes included intracranial hemorrhage, symptomatic intracranial hemorrhage (sICH) at 24–72 hours, and 90-day mortality. Multivariate logistic regression analyzed outcomes, with pre-specified subgroup and likelihood ratio tests to explore tirofiban–etiology interactions. Results Overall, tirofiban was not associated with favorable outcomes, mortality, or sICH. A potential interaction between tirofiban and etiology was observed for primary outcome (P=0.006). In non-AS BAO, tirofiban was associated with potentially improved reperfusion (97.1% vs 92.5%, P=0.016), higher favorable outcomes (adjusted OR (aOR) 2.06, 95% CI 1.21 to 3.54, P=0.009), and reduced mortality (P=0.036), with no increased bleeding risk. In AS BAO, no benefits were observed, and tirofiban was associated with increased futile reperfusion (P=0.043; P=0.012 for stroke etiology×tirofiban interaction). Conclusion Tirofiban may be associated with favorable outcomes in non-AS BAO without increasing hemorrhagic risk, whereas it confers no clear benefit and may elevate futile reperfusion in AS BAO. These findings support the concept of etiology-specific adjunctive therapy in BAO and underscore the need for prospective investigations of tirofiban in non-AS BAO populations.
Guo et al. (Tue,) conducted a cohort in Acute basilar artery occlusion (BAO) (n=221). Tirofiban vs. No tirofiban was evaluated on 90-day favorable function (modified Rankin Scale (mRS) 0-3) (aOR 2.06, 95% CI 1.21-3.54, p=0.009). In patients with non-atherosclerotic acute basilar artery occlusion, tirofiban was associated with higher 90-day favorable functional outcomes (aOR 2.06; 95% CI 1.21-3.54; P=0.009).