Key result
IV tirofiban during tandem occlusion thrombectomy and stenting shows favorable 90-day outcomes without symptomatic hemorrhage.
Why the study?
Optimal management of tandem occlusions remains under investigation, as carotid stenting with mechanical thrombectomy increases in-stent thrombosis risk while intraoperative antithrombotics elevate bleeding risk.
Case Report (n=1)
No
Perioperative intravenous tirofiban may be a safe and effective adjunct during mechanical thrombectomy and carotid stenting for tandem occlusions, even following prior fibrinolytic therapy.
No takes yet. Share an insight, caveat, or question.
May support tirofiban as safe adjunct post-fibrinolysis in tandem occlusion; hypothesis-generating pending larger confirmatory trials.
Large vessel occlusions associated with ipsilateral high-grade extracranial internal carotid artery stenosis, also called tandem occlusions, remain under investigation for optimal management. The risk of in-stent thrombosis is heightened for those who undergo carotid stenting in conjunction with mechanical thrombectomy (MT). Tirofiban, an intravenous antiplatelet agent functioning by binding the GIIb/IIIa receptors, inhibits platelet aggregation and has been used in cases of tandem occlusions to reduce the risk of in-stent thrombosis. Unfortunately, the bleeding risk is elevated in patients who receive intraoperative antithrombotics during stenting procedures, and especially those who undergo reperfusion therapy with prior fibrinolytic therapy. We present a case of tirofiban used to reduce the risk of in-stent thrombosis during MT and stenting of a carotid terminus tandem occlusion in a 64-year-old man. We aim to compare our case with currently published data on tirofiban use during similar procedures, with regard to indications for treatment, hemorrhagic events, and functional outcomes.
Polhemus et al. (2026) conducted a case report in Tandem occlusion (acute ischemic stroke) (n=1). Tirofiban was evaluated on Functional outcome (mRS) and symptomatic hemorrhage. Intravenous tirofiban administered during mechanical thrombectomy and carotid stenting for a tandem occlusion resulted in a favorable 90-day functional outcome (mRS 2) without symptomatic hemorrhage.
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