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Endovascular Thrombectomy.

Yuefei Wu¹, Congguo Yin², Jianhong Yang¹

¹From the Department of Neurology, Ningbo First Hospital, Zhejiang, China (Y.W., J.Y.).

|October 26, 2018

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Tirofiban use during endovascular treatment for acute ischemic stroke significantly increases the risk of symptomatic and fatal intracranial hemorrhage (ICH). This finding highlights potential safety concerns for this patient population.

Area of Science:

Neurology
Cardiology
Interventional Radiology

Background:

Acute ischemic stroke is a leading cause of disability.
Endovascular thrombectomy is a key treatment for acute ischemic stroke.
The safety profile of adjunctive therapies like tirofiban requires careful evaluation.

Purpose of the Study:

To investigate the safety of intra-arterial tirofiban in patients undergoing endovascular thrombectomy for acute ischemic stroke.
To compare the rates of symptomatic and fatal intracranial hemorrhage (ICH) between patients treated with and without tirofiban.

Main Methods:

Prospective study of 218 patients with acute ischemic stroke undergoing endovascular thrombectomy.
Comparison of 94 patients treated with intra-arterial tirofiban versus 124 patients not treated with tirofiban.

Keywords:

hemorrhage intracranial hemorrhage risk stroke thrombectomy

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Statistical analysis using chi-squared test and logistic regression to assess ICH rates.

Main Results:

Tirofiban-treated patients had a significantly higher rate of symptomatic ICH (14.6% vs. 5.7%, P=0.027).
Fatal ICH rates were also significantly higher in the tirofiban group (8.8% vs. 1.6%, P=0.014).
Tirofiban was associated with a 2.9-fold increased odds of symptomatic ICH and a 5.9-fold increased odds of fatal ICH.

Conclusions:

Intra-arterial tirofiban administration is associated with an increased risk of major intracranial hemorrhage following endovascular thrombectomy for acute ischemic stroke.
These findings suggest caution when using tirofiban in this clinical setting.
Further research, potentially including randomized controlled trials, is warranted to confirm these safety concerns.