Clinical Study Of Bridging Treatment Combined With Tirofiban In Acute Ischemic Stroke With Large Vessel Occlusion

Objective: The study evaluated preliminarily efficacy and safety of intravenous thrombolysis bridging mechanical thrombectomy combined with tirofiban in patients with acute ischemic stroke attributable to large artery occlusion.Methods: Patients with acute ischemic stroke due to large vessel occlusion who underwent mechanical thrombectomy with preceding intravenous thrombolysis(bridging treatment)from June 2017 to September 2020 in the stroke center of Linyi people’s hospital were enrolled and dichotomized into tirofiban(bridging treatment + tirofiban)and control group(bridging therapy only)according to whether intravenous tirofiban was performed during operation to observe the safety and efficacy of bridging therapy combined with tirofiban in acute ischemic stroke caused by large vessel occlusion.In effective outcome analysis,we followed up National Institutes of Health Stroke Scale(NIHSS)score to evaluate 7-day improvement of neurological function and modified Rankin Scale(m RS)score to assess 90-day clinical prognosis.To evaluate safety outcomes,the incidence of 7-day postoperative intracerebral hemorrhage,parenchymal hemorrhage type 2(PH2),symptomatic intracerebral hemorrhage(s ICH)and 90-day mortality were analyzed.Subgroup analyses were performed to further explore the effect of tirofiban on the clinical outcome of patients with different stroke etiology which was classified according to TOAST criteria.Then,the patients were split into favorable prognosis group(m RS≤2)and adverse prognosis group according to the prognosis 90 days after operation,and logistic regression for predictors of 90-day adverse functional outcomes was performed,which included the factors with significant statistical difference in univariate analysis(P < 0.05).Results: A total of 198 patients,including 125 in tirofiban group and 73 in the control group,were enrolled in this study.No significant differences of safety outcomes on intracerebral hemorrhage(18.4% vs 24.7%,P=0.294),PH2(4.8% vs 5.5%,P=1.000),s ICH(5.6% vs 8.2%,P=0.647)and 90 d mortality(15.2% vs 15.1%,P=0.980).Mean 7d NIHSS score of tirofiban group was 9(IQR,4-16),the control was 7(IQR,4-14),no significant differences between two groups(P=0.284).There were no differences in the rate of 90 d functional independence between the groups([m RS≤1]39.2% vs 34.2%,P=0.487;[m RS≤2] 60.8% vs 52.1%,P=0.230).In patients with large artery atherosclerosis(LAA)and cardioembolism(CE)stroke receiving bridging therapy,tirofiban was not associated with intracranial hemorrhage(LAA 16.8% vs 16.7%,P=1.000;CE 27.3% vs 27.3%,P=1.000),PH2(LAA 4.2% vs 8.3%,P=0.762;CE 9.1% vs2.3%,P=0.531),s ICH(LAA 5.3% vs 12.5%,P=0.419;CE 9.1% vs 6.8%,P=1.000)and mortality at 90-day(LAA 14.7% vs 29.2%,P=0.175;CE 18.2% vs 9.1 %,P=0.505).Logistic regression found diabetes mellitus(OR=2.499,95%CI=1.196-5.225,P=0.015),general anesthesia(OR=2.605,95%CI=1.182-5.741,P=0.018),times of stent thrombectomy(OR=1.744,95%CI=1.210-2.541,P=0.003)and s ICH(OR=5.771,95%CI=1.141-29.182,P=0.034)to be independent predictors for poor prognosis,but tirofiban had no effect on clinical outcome.Conclusions: In patients with acute ischemic stroke caused by large vessel occlusion who underwent intravenous thrombolysis bridging mechanical thrombectomy,intravenous administration of tirofiban may be relatively safe,and its clinical efficacy needs to be further verified by large sample randomized controlled trials or systematic evaluation.