Abstract:

Objective: To investigate the efficacy and safety of tirofiban application during emergency endovascular treatment in patients with acute ischemic stroke due to large artery atherosclerosis (LAA). Methods: A total of 326 patients diagnosed with acute ischemic stroke due to LAA and subjected to emergency endovascular treatment at The First Affiliated Hospital of Xi/an Jiaotong University from January 2019 to June 2023 were enrolled. All patients underwent endovascular treatment and were divided into tirofiban group (n = 183) and non-tirofiban group (n = 143) based on intraoperative tirofiban application. The primary outcome was defined as the modified Rankin Scale (mRS) score of 0-2 (functional independence) at 90 d postoperatively. Secondary outcomes were included mRS score of 0-1 (excellent prognosis) at 90 d, the mRS score of 0-3 (favorable prognosis) at 90 d, and modified Thrombolysis in Cerebral Infarction (mTICI) ≥ 2b (successful recanalization). Security indicators were included the incidence of symptomatic intracranial hemorrhage (sICH) within 24 h postoperatively, the incidence of intracranial hemorrhage (ICH) within 24 h postoperatively, and the all-cause mortality at 90 d postoperatively. Results: Regarding the primary outcome, no statistically significant difference was observed between the 2 groups in the proportion of patients achieving the mRS score of 0-2 at 90 d postoperatively (χ² = 0.703, P = 0.402). For secondary outcomes, there were no significant differences between the 2 groups in the following measures: mRS score of 0-1 at 90 d postoperatively (χ² = 0.359, P = 0.549), mRS score of 0-3 at 90 d postoperatively (χ² = 2.513, P = 0.113), mTICI ≥ 2b postoperatively (χ² = 0.763, P = 0.384). In terms of security indicators, no statistically significant differences were observed between the 2 groups in the following: incidence of sICH (χ² = 0.257, P = 0.612), incidence of ICH (χ² = 3.561, P = 0.059) at 24 h postperatively, all-cause mortality at 90 d postoperatively (χ² = 0.370, P = 0.543). Logistic regression analysis showed that intraoperative tirofiban application was not an independent predictor of functional independence (mRS score of 0-2) at 90 d postoperatively. Conclusions: In patients with acute ischemic stroke due to LAA, the tirofiban application during emergency endovascular treatment did not significantly improve clinical outcomes. However, it was not associated with an increased risk of ICH or mortality.

Key words: Ischemic stroke, Atherosclerosis, Thrombectomy, Stents, Saccule and utricle, Tirofiban

摘要：

目的: 探讨大动脉粥样硬化(LAA)型急性缺血性卒中患者血管内治疗中应用替罗非班的有效性和安全性。方法: 纳入2019年1月至2023年6月在西安交通大学第一附属医院诊断为LAA型急性缺血性卒中并接受急诊血管内治疗的患者共326例, 根据术中是否应用替罗非班分为替罗非班组(183例)和非替罗非班组(143例)。以术后90 d改良Rankin量表(mRS)评分为0 ~ 2分(功能独立)作为主要结局指标; 以术后90 d mRS评分0 ~ 1分(优秀预后)、术后90 d mRS评分0 ~ 3分(较好预后)、术后即刻改良脑梗死溶栓血流分级(mTICI)≥ 2b级(血管再通)作为次要结局指标; 将术后24 h内症状性颅内出血发生率、术后24 h内颅内出血发生率、术后90 d全因死亡率作为安全性指标。结果: 主要结局方面, 两组术后90 d mRS评分0 ~ 2分差异无统计学意义(χ² = 0.703, P = 0.402);次要结局方面, 两组术后90 d mRS评分0 ~ 1分(χ² = 0.359, P = 0.549)、术后90 d mRS评分0 ~ 3分(χ² = 2.513, P = 0.113)、术后即刻mTICI分级≥ 2b级(χ² = 0.763, P = 0.384)差异均无统计学意义; 安全性方面, 两组术后24 h内症状性颅内出血发生率(χ² = 0.257, P = 0.612)、术后24 h内颅内出血发生率(χ² = 3.561, P = 0.059)、术后90 d全因死亡率(χ² = 0.370, P = 0.543)差异均无统计学意义。Logistic回归分析显示, 术中应用替罗非班并非术后90 d功能独立的影响因素。结论: LAA型急性缺血性卒中患者急诊血管内治疗中应用替罗非班未能有效改善预后, 但并不增加颅内出血或死亡风险。

关键词: 缺血性卒中, 动脉粥样硬化, 血栓切除术, 支架, 球囊和椭圆囊, 替罗非班