Tirofiban on First-Pass Recanalization in Acute Stroke Endovascular Thrombectomy

作者：Longting Lin, Feifeng Liu, Tingyu Yi, Yueqi Zhu, Jianhong Yang, Yanxin Zhao, Feng Wang, Guangyu Xiang, Chen Chen, Yaping Xiao, Hao Shen, Luran Xu, Yuming Long, Yue Zhang, Zhengyu Huang, Chushuang Chen, Leonid P. Churilov, Mark Parsons, Wenhuo Chen, Gang Li, OPTIMISTIC Investigators, Yuming Long, Yue Zhang, Zhengyu Huang, Hao Zhang, Chenxi Jiang, Zhuojun Xu, Qiwei Wang, Yongpeng Wang, Min Yu, Wenhao Yang, Xiafei Wang, Fu Wang, Yanmin Wu, Ding-lai Lin, Xiaohui Lin, Zhi-nan Pan, Lisan Zeng, Yunlong He, Xiaoyan Chen, Jialong Zhou, Fangzhuo Zhao, Tianrui Zhu, Dong Wang, Meilong Gao, Wanda Shi, Jiangshan Deng, Haitao Lu, Liming Wei, Yi Gu, Yiran Zhang, Zhigang He, Yali Liang, Zhe Qian, Ping Guo, Zhenzhen Pan, Yue-Fei Wu, Yueshi Huang, Renshuai Liu, Chao Wei, Dong Han · 发表于：JAMA Network Open · 年份：2025 · DOI：10.1001/jamanetworkopen.2025.5308 · 被引用次数：19 · 研究领域：Acute Ischemic Stroke Management、Intracerebral and Subarachnoid Hemorrhage Research、Atrial Fibrillation Management and Outcomes

Importance: Tirofiban is a nonpeptide antagonist of the glycoprotein IIb/IIIa receptor that inhibits platelet aggregation selectively. Despite widespread use in acute ischemic stroke in conjunction with endovascular treatment, the role of tirofiban is uncertain. Objective: To assess whether intravenous tirofiban initiated before endovascular thrombectomy improves thrombectomy outcomes by achieving first-pass recanalization without intracranial hemorrhagic risk. Design, Setting, and Participants: This was a multicenter, prospective, open-label, blinded, end point phase 2 randomized clinical trial that enrolled patients from 7 Chinese hospital stroke centers between April 30, 2021, and July 16, 2023. Eligible patients were aged 18 to 85 years with large vessel occlusion (internal carotid artery or M1 or M2 segment of middle cerebral artery) and were considered for endovascular thrombectomy within 24 hours of ischemic stroke onset or last known well time. Patients with a history of atrial fibrillation or treated with intravenous thrombolysis were excluded. Intervention: Patients were randomly assigned (1:1) to intravenous tirofiban (10 μg/kg bolus plus 0.1 μg/kg per minute infusion for 24 hours) or standard care before endovascular thrombectomy using a web-based, computer-generated randomization procedure. Main Outcomes and Measures: The primary outcome was the proportion of patients achieving first-pass recanalization without symptomatic intracranial hemorrhage. First-pass reca...