Association of Tirofiban With Functional Outcomes After Thrombectomy in Acute Ischemic Stroke Due to Intracranial Atherosclerotic Disease

作者：Hongfei Sang, Dongjing Xie, Yan Tian, Thanh N. Nguyen, Jeffrey L. Saver, Raul G. Nogueira, Junxiong Wu, Long Chen, Zhenxuan Tian, Zhizhou Hu, Tao Wang, Rongzong Li, Yingbing Ke, Xiurong Zhu, Daizhou Peng, Mingze Chang, Lingfei Li, Jie Ruan, Deping Wu, Wenjie Zi, Qingwu Yang, Fengli Li, Zhongming Qiu · 发表于：Neurology · 年份：2023 · DOI：10.1212/wnl.0000000000207194 · 被引用次数：72 · 研究领域：Acute Ischemic Stroke Management、Cerebrovascular and Carotid Artery Diseases、Antiplatelet Therapy and Cardiovascular Diseases

Background and Objective To investigate the efficacy and safety of IV infusion of tirofiban before endovascular thrombectomy for patients with large vessel occlusion due to intracranial atherosclerotic disease. The secondary objective was to identify potential mediators for the clinical effect of tirofiban. Methods Post hoc exploratory analysis of the Endovascular Treatment With versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke (RESCUE BT) trial, which was a randomized, double-blinded, placebo-controlled trial at 55 centers in China from October 2018 to October 2021. Patients with occlusion of the internal carotid artery or middle cerebral artery due to intracranial atherosclerosis were included. The primary efficacy outcome was the proportion of patients achieving functional independence (defined as modified Rankin scale 0–2) at 90 days. Binary logistic regression and causal mediation analyses were used to estimate the treatment effect of tirofiban and the potential mediators. Results This study included 435 patients, of whom 71.5% were men. The median age was 65 (interquartile range [IQR] 56–72) years, with a median NIH Stroke Scale of 14 (IQR 10–19). Patients in the tirofiban group had higher rates of functional independence at 90 days than patients in the placebo group (adjusted odds ratio 1.68; 95% CI 1.11–2.56, p = 0.02) without an increased risk of mortality or symptomatic intracranial hemorrhage. Tirofiban was associated with fewer thromb...