The Role of Intravenous Tirofiban in Patients Undergoing Endovascular Treatment for Acute Intracranial Atherosclerotic Occlusion

Previous reports regarding the impact of tirofiban on patients undergoing endovascular treatment for acute ischemic stroke have shown inconsistencies. In this study, we specifically focused on patients with intracranial atherosclerotic disease to evaluate the effectiveness and safety of intravenous tirofiban during endovascular treatment. The participants were sourced from the ANGEL-ACT Registry (a prospective multicenter registry study focused on key endovascular treatment techniques and emergency workflow improvement for acute ischemic stroke) and categorized into two groups. The treatment group (IV-tirofiban group, n=254) underwent continuous intravenous administration of tirofiban, whereas the control group (No IV-tirofiban group, n=248) did not receive intravenous tirofiban. A 1:1 propensity score matching (PSM) was subsequently conducted between the two groups. We compared the outcomes between the two groups in both the pre-matched and post-matched populations. The median (interquartile range IQR) of 90-day modified Rankin Scale (mRS) score was 3 (0-5) in the control group and 1 (0-4) in the IV-tirofiban group. The adjusted common odds ratio (OR) for the ordinal distribution of the 90-day mRS was 1.61 (95% CI, 1.12-2.31; P=0.010). The rates of excellent outcomes were 42.3% in the control group and 50.4% in the IV-tirofiban group, with an adjusted OR of 1.59 (95% CI, 1.04-2.42; P=0.032). The rates of functional independence were 44.0% in the control group and 53.5% in the IV-tirofiban group, with an adjusted OR of 1.72 (95% CI, 1.13-2.63; P=0.012). The rates of complete recanalization were 52.4% in the control group and 65.4% in the IV-tirofiban group, with an adjusted OR of 1.58 (95% CI, 1.04-2.40; P=0.033). In the analysis of post-matched outcomes, only the outcome of complete recanalization rates differed between the two groups, with an OR of 1.79 (95% CI, 1.09-2.97; P=0.023). The use of intravenous tirofiban as an adjunctive treatment can potentially improve the prognosis of patients undergoing endovascular treatment for intracranial atherosclerotic large vessel occlusion. http://www. gov. Unique identifier: NCT03370939.