The impact of intraarterial, intravenous, and combined tirofiban on endovascular treatment for acute intracranial...

Area of Science:

• Neurology
• Cardiovascular Medicine
• Interventional Radiology

Background:

• Endovascular treatment (EVT) for acute large vessel occlusion (LVO) is a critical intervention for ischemic stroke.
• The role of adjunctive tirofiban in EVT for LVO remains controversial, particularly in patients with intracranial atherosclerotic disease (ICAD).
• Different administration routes of tirofiban (intra-arterial, intravenous, or combined) may influence treatment efficacy and safety.

Purpose of the Study:

• To compare the effectiveness and safety of different tirofiban administration pathways in patients undergoing EVT for acute LVO with ICAD.
• To evaluate the impact of intra-arterial (IA), intravenous (IV), and combined IA+IV tirofiban administration versus no tirofiban on clinical outcomes.

Main Methods:

• Analysis of data from the prospective ANGEL-ACT Registry, including 502 patients with acute LVO and ICAD.
• Patients were categorized into four groups: IA-tirofiban, IV-tirofiban, IA+IV-tirofiban, and non-tirofiban.
• Outcomes were assessed using 90-day modified Rankin Scale (mRS) scores, functional outcomes (mRS 0-1, 0-2, 0-3), successful recanalization, and safety endpoints (symptomatic intracranial hemorrhage).
• Multivariable logistic regression and propensity score matching (PSM) were employed to adjust for confounders and compare outcomes between groups.

Main Results:

• After PSM, intra-arterial tirofiban administration was associated with significantly worse 90-day ordinal mRS distribution (OR, 0.41; P=0.036) compared to no tirofiban.
• IA-tirofiban also showed significantly worse outcomes for mRS 0-1 (OR, 0.28; P=0.011) and mRS 0-2 (OR, 0.25; P=0.006) at 90 days.
• No significant differences in other secondary outcomes or safety endpoints were observed between the IA-tirofiban group and the non-tirofiban group after PSM.

Conclusions:

• Intra-arterial administration of tirofiban in patients undergoing EVT for ICAD-LVO appears to be associated with poorer functional outcomes.
• These findings suggest a potentially harmful effect of IA tirofiban in this specific patient population.
• Further research is needed to elucidate the mechanisms behind this association and to guide optimal antiplatelet strategies in EVT for ICAD-LVO.