| Objective: To investigate the safety and efficacy of tirofiban in combination with intravascular therapy(EVT)in acute great vessel occlusional ischemic stroke(AIS-LVO).Methods: Patients diagnosed with AIS-LVO and undergoing EVT in Affiliated Hospital of Yangzhou University from January 2018 to December 2021 were retrospectively analyzed,including mechanical thrombectomy and intravenous thrombolysis(IVT)post-bridging thrombectomy.Patients were divided into Tirofiban group and control group according to whether tirofiban was used intraoperand and postoperative.Tirofiban group was injected with 0.5-1.0mg tirofiban in the catheter intraoperatively and maintained at 0.2-0.25mg/h for 24 h postoperatively,while control group received conventional treatment after EVT.General data were collected,including age,gender,IVT bridging treatment,past medical history,relevant laboratory findings and imaging findings showing the infarct site.For the safety outcome,intracranial hemorrhage(ICH),symptomatic intracranial hemorrhage(SICH),fatal intracranial hemorrhage(f CIH)and other systematic non-fatal hemorrhage were recorded respectively.For the curative outcome,the improvement of neurological function at 7 days was mainly analyzed.A4-point decline in the National Institutes of Health Stroke Scale(NIHSS)score from admission at 7 days was defined as an improvement in neurological function,and a 0-2score on the Modified Rankin Scale(m RS)score at 90 days was defined as a good prognosis,and death at 90 days.According to the 90 d m RS Score,the patients were divided into the good prognosis group(0-2 points)and the poor prognosis group(> 2points).Univariate analysis was performed between the two groups,and then variables with p < 0.05 in the univariate analysis were included in the binary logistic regression analysis,and the independent risk factors of prognosis were analyzed.Results: According to the inclusion and exclusion criteria,a total of 99 patients were included,including 48 in the tirofiban group and 51 in the control group.The control group was relatively older than the tirofiban group(64.0 vs 73.0,p < 0.001)and had a higher prevalence of atrial fibrillation(4.2% vs 26.7%,p < 0.001).The Tirofiban group tended to have more postcirculation infarcts(33.3% vs 9.8%,p=0.004).There were no significant differences in laboratory results between the two groups,including white blood cell count,neutrophil count,platelet count,alanine aminotransferase,aspartate aminotransferase,urea,creatinine,triglyceride,total cholesterol,LDL,HDL,and glycosylated hemoglobin(p > 0.05).Safety and efficacy outcomes were analyzed,including ICH(10.4% vs 23.5% p=0.084),s ICH(6.2% vs 3.9% p=0.597),f ICH(4.2% vs2.0 p=0.141),Non-fatal bleeding in other systems(12.5% vs 9.5% p=552)had no significant difference in any of the four safety outcome factors.Therapeutic outcomes include: Neurological improvement at day 7(64.6% vs 72.5% p=0.393),good prognosis at day 90(68.8% vs 47.1% p=0.029),and death at day 90(4.2% vs 5.9% p=0.697)were significantly different between the two groups in good prognosis at day 90.The probability of good prognosis in Tirofiban group was significantly better than that in control group.Then,univariate analysis was conducted for prognosis.Variables with p <0.2 in univariate analysis were included in binary logistic regression analysis,so as to analyze independent risk factors for prognosis.Binary logistic regression analysis for prognosis showed that baseline NIHSS score(OR=1.128,95%CI =1.037-1.227,P=0.005)was an independent risk factor for poor prognosis,and tirofiban use was not a risk factor for poor prognosis.onclusions: The use of tirofiban in AIS-LVO EVT is safe and has good efficacy for long-term prognosis. |
PDF Full Text Request