Tirofiban in Acute Ischemic Stroke Patients Undergoing Endovascular Thrombectomy with Preceding intravenous Thrombolysis

Background The effectiveness of Tirofiban administration to acute ischemic stroke patients undergoing endovascular thrombectomy (EVT) after intravenous thrombolysis (IVT) remains unclear. This study examined the effect of intraarterial or intravenous tirofiban during endovascular thrombectomy following thrombolysis. Methods Patients with acute ischemic stroke who received EVT after thrombolysis were selected from the International Stroke Perfusion Imaging Registry, and divided into three groups according to tirofiban administration. Safety outcomes were symptomatic intracerebral hemorrhage (sICH) and parenchymal hematoma type-2 (PH2). Efficacy outcomes included successful recanalization, complete recanalization, functional independence, and death at 3-months. Univariate and multivariate regression estimates are listed as “estimate [95% confidence interval] p-value”. Results We analyzed a total of 682 patients who underwent EVT after IVT. Among them, 53 (7.77%) were treated with intraarterial tirofiban (IA-tirofiban group), 80 (11.73%) were treated with intravenous tirofiban (IV-tirofiban group), while 549 (80.50%) patients were not treated with tirofiban (non-tirofiban group). There were no significant differences between groups in the incidences of PH2 or sICH ( P =0.413, P =0.256). There were significant differences in successful recanalization, functional independence, and death at 3-months ( P =0.031, P <0.001, P =0.010). There was no difference between IA-tirofiban and non-tirofiban in terms of safety or efficacy outcomes. Compared with non-tirofiban, IV-tirofiban was not associated with PH2 ( P =0.111; adjusted P =0.705) or sICH ( P =0.263; adjusted P =0.168), but was associated with higher odds of successful recanalization (OR=8.94 [1.22–65.53], P =0.031; adjusted OR=8.24 [1.08–62.59], adjusted P =0.041), 3-month functional independence (OR=3.21 [1.88–5.50], P <0.001; adjusted OR=2.22 [1.21–4.12], adjusted P =0.011) and lower odds of 3-month death (OR=0.20 [0.17–0.27], P =0.007; adjusted OR=0.25 [0.07–0.92], adjusted P =0.039). Conclusions In acute ischemic stroke patients undergoing mechanical thrombectomy with preceding intravenous thrombolysis, both intraarterial and intravenous tirofiban could be safe. However, only intravenous tirofiban was associated with clinical benefit. Further randomized clinical trials are needed to confirm these findings.