Acute stenting with subsequent tirofiban bridging in stroke patients was not associated with an increased risk of any intracerebral hemorrhage (OR 0.863) compared to thrombectomy alone.
Cohort (n=195)
No
Does bridging antiplatelet therapy with intravenous tirofiban after emergency stenting improve outcomes and maintain safety compared to thrombectomy alone in patients with acute ischemic stroke?
Bridging antiplatelet therapy with intravenous tirofiban after emergency stenting in acute ischemic stroke appears safe and is not associated with an increased risk of intracerebral hemorrhage or in-hospital death compared to thrombectomy alone.
Odds Ratio: 0.863 (95% CI 0.37–2.013)
Absolute Event Rate: 20% vs 20%
p-value: p=0.734
BACKGROUND: In a proportion of stroke patients with acute large vessel occlusion permanent stent implantation is mandatory to achieve successful recanalization. The optimum platelet inhibition strategy after such emergency stenting is unknown. We therefore analyzed the outcome of early glycoprotein (gp) IIb/IIIa inhibitor treatment after emergency stenting in acute stroke. METHODS: Sixty patients with emergency stenting were identified in our stroke unit registry from 12/2010-06/2014 and analyzed retrospectively. All patients were bridged intravenously with the gpIIb/IIIa antagonist tirofiban immediately after the acute procedure until switching to oral aspirin and clopidogrel was performed. For comparison we studied 135 patients with M1 occlusion undergoing thrombectomy without stent implantation or tirofiban treatment in a propensity score-adjusted analysis. RESULTS: In the acute stenting group receiving tirofiban complications with 6 deaths during the hospital stay (10%), 2 reinfarctions (3%), 12 intracerebral hemorrhages (ICH; 20%) and 5 symptomatic ICH (8%) occurred. Thirty-seven patients (62%) reached a moderate outcome of mRS 0-3 after 90 days. In the thrombectomy group without tirofiban administration the rate of deaths within hospital stay, the rate of ICH and outcome at day 90 were not different. CONCLUSION: In our retrospective study acute stenting with subsequent gpIIb/IIIa inhibition was not associated with an increased risk of ICH or in-hospital death.
Lee et al. (Wed,) conducted a cohort in Acute ischemic stroke with large vessel occlusion (n=195). Tirofiban bridging after emergency stenting vs. Endovascular thrombectomy without stent implantation or tirofiban was evaluated on Any intracerebral hemorrhage (ICH) (OR 0.863, 95% CI 0.370-2.013, p=0.734). Acute stenting with subsequent tirofiban bridging in stroke patients was not associated with an increased risk of any intracerebral hemorrhage (OR 0.863) compared to thrombectomy alone.