February 16, 2023CardioVascular and Interventional RadiologyOpen Access

Comparison of Safety and Efficacy after Emergency Stenting in Patients Exhibiting Intracranial Atherosclerotic Stenosis Associated with Large-vessel Occlusion with and without Intravenous Infusion of Tirofiban

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Why the study?

Intracranial rescue stent angioplasty is used for acute stroke after failed thrombectomy due to atherosclerotic stenosis, but consensus on peri-interventional antiplatelet regimens is lacking.

Does peri-interventional intravenous tirofiban improve safety and functional outcomes in patients undergoing rescue stenting for acute ischemic stroke with large-vessel occlusion?

Population

78 acute ischaemic stroke patients receiving rescue stent angioplasty

Comparison

Peri-interventional intravenous tirofiban vs no tirofiban

Design

Single-centre retrospective analysis

Follow-up

3 months

Authors

RGRana GarayzadeUniversity Hospital Augsburg ABAnsgar BerlisUniversity of Augsburg SSStefan SchieleAugsburg University

Discussion

Member takes

Implication

Tirofiban use showed comparable safety and outcomes; leaves open optimal regimens pending prospective trials.

Structured PICO

Does peri-interventional intravenous tirofiban improve safety and functional outcomes in patients undergoing rescue stenting for acute ischemic stroke with large-vessel occlusion?

Population

78 patients treated with rescue stent angioplasty between 2010 and 2019 due to acute ischaemic stroke (failed endovascular thrombectomy due to underlying atherosclerotic stenosis). Median age 70.6 in tirofiban group and 73.3 in control group.

Intervention

Peri-interventional intravenous tirofiban (25 mcg/kg bolus within 3 min during stenting followed by 0.15 mcg/kg/min for up to 24 h)

Comparator

No intravenous tirofiban (control group received inhomogeneous antiplatelet regimens including ASA monotherapy, ASA with clopidogrel/heparin/ticagrelor/i.a. rtPA, heparin alone, clopidogrel alone, or no medication)

Outcome

Symptomatic haemorrhagesafety

Intravenous tirofiban appears safe for rescue stenting after failed mechanical thrombectomy in acute ischemic stroke, with no significant increase in symptomatic hemorrhage compared to other antiplatelet regimens.

Limitations

Small overall sample size
Retrospective study design
Inhomogeneous use of antiplatelet agents in the control group before institutional standardization
Limited sufficient follow-up

Cite This Study

Garayzade et al. (2023) studied this question.

synapsesocial.com/papers/6a871b7a7fdf9298f89ece22 https://doi.org/10.1007/s00270-023-03372-7

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Comparison of Safety and Efficacy after Emergency Stenting in Patients Exhibiting Intracranial Atherosclerotic Stenosis Associated with Large-vessel Occlusion with and without Intravenous Infusion of Tirofiban

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Comparison of Safety and Efficacy after Emergency Stenting in Patients Exhibiting Intracranial Atherosclerotic Stenosis Associated with Large-vessel Occlusion with and without Intravenous Infusion of Tirofiban

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider