Safety and Efficacy of Low-Dose Tirofiban Combined With Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischemic Stroke: A Matched-Control Analysis From a Nationwide Registry

被引：21

作者：

Ma, Gaoting ^{[1
]}

Li, Shuo ^{[1
]}

Jia, Baixue ^{[1
]}

Mo, Dapeng ^{[1
]}

Ma, Ning ^{[1
]}

Gao, Feng ^{[1
]}

Huo, Xiaochuan ^{[1
]}

Luo, Gang ^{[1
]}

Wang, Anxin ^{[2
]}

Pan, Yuesong ^{[2
]}

Song, Ligang ^{[1
]}

Sun, Xuan ^{[1
]}

Zhang, Xuelei ^{[1
]}

Gui, Liqiang ^{[3
]}

Song, Cunfeng ^{[4
]}

Peng, Ya ^{[5
]}

Wu, Jin ^{[6
]}

Zhao, Shijun ^{[7
]}

Zhao, Junfeng ^{[8
]}

Zhou, Zhiming ^{[9
]}

Miao, Zhongrong ^{[1
]}

机构：

[1] Capital Med Univ, Beijing Tiantan Hosp, Intervent Neuroradiol Ctr, Beijing, Peoples R China

[2] Capital Med Univ, Beijing Tiantan Hosp, Dept Neurol, Beijing, Peoples R China

[3] Langfang Changzheng Hosp, Dept Intervent Neuroradiol, Langfang, Peoples R China

[4] Liao Cheng Third Peoples Hosp, Dept Intervent Neuroradiol, Liaocheng, Shandong, Peoples R China

[5] Soochow Univ, Affiliated Hosp 3, Peoples Hosp Changzhou 1, Dept Neurosurg, Changzhou, Jiangsu, Peoples R China

[6] Nanjing Med Univ, Affiliated Hosp 2, Dept Neurol, Nanjing, Peoples R China

[7] Fengrun Dist Peoples Hosp Tangshan City, Dept Intervent Radiol, Tangshan, Peoples R China

[8] SiPing Cent Peoples Hosp, Dept Neurol, Siping, Peoples R China

[9] Wannan Med Coll, Yijishan Hosp, Dept Neurol, Wuhu, Peoples R China

来源：

FRONTIERS IN NEUROLOGY | 2021年 / 12卷

基金：

中国国家自然科学基金;

关键词：

tirofiban; mechanical thrombectomy; intravenous thrombolysis; large vessel occlusion; propensity score matching; THERAPY; RISK;

D O I：

10.3389/fneur.2021.666919

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Purpose: Tirofiban administration to acute ischemic stroke patients undergoing mechanical thrombectomy with preceding intravenous thrombolysis remains controversial. The aim of the current study was to evaluate the safety and efficacy of low-dose tirofiban during mechanical thrombectomy in patients with preceding intravenous thrombolysis. Methods: Patients with acute ischemic stroke undergoing mechanical thrombectomy and preceding intravenous thrombolysis were derived from "ANGEL-ACT," a multicenter, prospective registry study. The patients were dichotomized into tirofiban and non-tirofiban groups based on whether tirofiban was administered. Propensity score matching was used to minimize case bias. The primary safety endpoint was symptomatic intracerebral hemorrhage (sICH), defined as an intracerebral hemorrhage (ICH) associated with clinical deterioration as determined by the Heidelberg Bleeding Classification. All ICHs and hemorrhage types were recorded. Clinical outcomes included successful recanalization, dramatic clinical improvement, functional independence, and mortality at the 3-month follow-up timepoint. Successful recanalization was defined as a modified Thrombolysis in Cerebral Ischemia score of 2b or 3. Dramatic clinical improvement at 24 h was defined as a reduction in NIH stroke score of >= 10 points compared with admission, or a score <= 1. Functional independence was defined as a Modified Rankin Scale (mRS) score of 0-2 at 3-months. Results: The study included 201 patients, 81 in the tirofiban group and 120 in the non-tirofiban group, and each group included 68 patients after propensity score matching. Of the 201 patients, 52 (25.9%) suffered ICH, 15 (7.5%) suffered sICH, and 18 (9.0%) died within 3-months. The median mRS was 3 (0-4), 99 (49.3%) achieved functional independence. There were no statistically significant differences in safety outcomes, efficacy outcomes on successful recanalization, dramatic clinical improvement, or 3-month mRS between the tirofiban and non-tirofiban groups (all p > 0.05). Similar results were obtained after propensity score matching. Conclusion: In acute ischemic stroke patients who underwent mechanical thrombectomy and preceding intravenous thrombolysis, low-dose tirofiban was not associated with increased risk of sICH or ICH. Further randomized clinical trials are needed to confirm the effects of tirofiban in patients undergoing bridging therapy.

引用

页数：8

共 25 条

[1] Vessel wall signal enhancement on 3-T MRI in acute stroke patients after stent retriever thrombectomy [J].

Abraham, Peter ;

Pannell, J. Scott ;

Santiago-Dieppa, David R. ;

Cheung, Vincent ;

Steinberg, Jeffrey ;

Wali, Arvin ;

Gupta, Mihir ;

Rennert, Robert C. ;

Lee, Roland R. ;

Khalessi, Alexander A. .

NEUROSURGICAL FOCUS, 2017, 42 (04)

[2] Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging [J].

Albers, G. W. ;

Marks, M. P. ;

Kemp, S. ;

Christensen, S. ;

Tsai, J. P. ;

Ortega-Gutierrez, S. ;

McTaggart, R. A. ;

Torbey, M. T. ;

Kim-Tenser, M. ;

Leslie-Mazwi, T. ;

Sarraj, A. ;

Kasner, S. E. ;

Ansari, S. A. ;

Yeatts, S. D. ;

Hamilton, S. ;

Mlynash, M. ;

Heit, J. J. ;

Zaharchuk, G. ;

Kim, S. ;

Carrozzella, J. ;

Palesch, Y. Y. ;

Demchuk, A. M. ;

Bammer, R. ;

Lavori, P. W. ;

Broderick, J. P. ;

Lansberg, M. G. .

NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (08) :708-718

[3] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[4] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[5] Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[6] Safety and Efficacy of Tirofiban During Mechanical Thrombectomy for Stroke Patients with Preceding Intravenous Thrombolysis [J].

Huo, Xiaochuan ;

Yang, Ming ;

Ma, Ning ;

Gao, Feng ;

Mo, Dapeng ;

Li, Xiaoqing ;

Wang, Anxin ;

Wang, Yongjun ;

Miao, Zhongrong .

CLINICAL INTERVENTIONS IN AGING, 2020, 15 :1241-1248

[7] Current Status of Endovascular Treatment for Acute Large Vessel Occlusion in China A Real-World Nationwide Registry [J].

Jia, Baixue ;

Ren, Zeguang ;

Mokin, Maxim ;

Burgin, W. Scott ;

Bauer, Clayton T. ;

Fiehler, Jens ;

Mo, Dapeng ;

Ma, Ning ;

Gao, Feng ;

Huo, Xiaochuan ;

Luo, Gang ;

Wang, Anxin ;

Pan, Yuesong ;

Song, Ligang ;

Sun, Xuan ;

Zhang, Xuelei ;

Gui, Liqiang ;

Song, Cunfeng ;

Peng, Ya ;

Wu, Jin ;

Zhao, Shijun ;

Zhao, Junfeng ;

Zhou, Zhiming ;

Li, Yongli ;

Jing, Ping ;

Yang, Lei ;

Liu, Yajie ;

Zhao, Qingshi ;

Liu, Yan ;

Peng, Xiaoxiang ;

Gao, Qingchun ;

Guo, Zaiyu ;

Chen, Wenhuo ;

Li, Weirong ;

Cheng, Xiaojiang ;

Xu, Yun ;

Zhang, Yongqiang ;

Zhang, Guilian ;

Lu, Yijiu ;

Lu, Xinyu ;

Wang, Dengxiang ;

Wang, Yan ;

Li, Hao ;

Ling, Li ;

Peng, Guangge ;

Zhang, Jingyu ;

Zhang, Kai ;

Li, Shuo ;

Qi, Zhongqi ;

Xu, Haifeng .

STROKE, 2021, 52 (04) :1203-1212

[8] Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke [J].

Jovin, T. G. ;

Chamorro, A. ;

Cobo, E. ;

de Miquel, M. A. ;

Molina, C. A. ;

Rovira, A. ;

San Roman, L. ;

Serena, J. ;

Abilleira, S. ;

Ribo, M. ;

Millan, M. ;

Urra, X. ;

Cardona, P. ;

Lopez-Cancio, E. ;

Tomasello, A. ;

Castano, C. ;

Blasco, J. ;

Aja, L. ;

Dorado, L. ;

Quesada, H. ;

Rubiera, M. ;

Hernandez-Perez, M. ;

Goyal, M. ;

Demchuk, A. M. ;

von Kummer, R. ;

Gallofre, M. ;

Davalos, A. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (24) :2296-2306

[9] Endovascular Stroke Therapy Tirofiban Is Associated With Risk of Fatal Intracerebral Hemorrhage and Poor Outcome [J].

Kellert, Lars ;

Hametner, Christian ;

Rohde, Stefan ;

Bendszus, Martin ;

Hacke, Werner ;

Ringleb, Peter ;

Stampfl, Sibylle .

STROKE, 2013, 44 (05) :1453-+

[10] Dramatic Recovery in Acute Ischemic Stroke Is Associated With Arterial Recanalization Grade and Speed [J].

Mazighi, Mikael ;

Meseguer, Elena ;

Labreuche, Julien ;

Serfaty, Jean-Michel ;

Laissy, Jean-Pierre ;

Lavallee, Philippa C. ;

Cabrejo, Lucie ;

Guidoux, Celine ;

Lapergue, Bertrand ;

Klein, Isabelle F. ;

Olivot, Jean-Marc ;

Rouchaud, Aymeric ;

Desilles, Jean-Philippe ;

Schouman-Claeys, Elisabeth ;

Amarenco, Pierre .

STROKE, 2012, 43 (11) :2998-3002

← 1 2 3 →