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Rodrigo-Gisbert M, Hoferica M, García-Tornel A, Requena M, Rubiera M, Lascuevas MDD, Olivé-Gadea M, Diana F, Rizzo F, Muchada M, Carmona T, Rodriguez-Villatoro N, Rodríguez-Luna D, Juega J, Pagola J, Hernández D, Molina CA, Tomasello A, Cognard C, Ribó M. Stent Retriever AssIsted Lysis Technique with Tirofiban: A Potential Bailout Alternative to Angioplasty and Stenting. AJNR Am J Neuroradiol 2024:ajnr.A8374. [PMID: 38849135 DOI: 10.3174/ajnr.a8374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND AND PURPOSE Angioplasty and stent placement have been described as a bailout technique in individuals with failed thrombectomy. We aimed to investigate Stent retriever AssIsted Lysis (SAIL) with tirofiban before angioplasty and stent placement. MATERIALS AND METHODS Patients from 2 comprehensive stroke centers were reviewed (2020-2023). We included patients with failed thrombectomy and/or underlying intracranial stenosis who received SAIL with tirofiban before the intended angioplasty and stent placement. SAIL consisted of deploying a stent retriever through the occluding lesion to create a bypass channel and infuse 10 mL of tirofiban for 10 minutes either intra-arterially or IV. The stent retriever was re-sheathed before retrieval. The primary end points were successful reperfusion (expanded TICI 2b-3) and symptomatic intracerebral hemorrhage. Additional end points included 90-day mRS 0-2 and mortality. RESULTS After a median of 3 (interquartile range, 2-4) passes, 44 patients received the SAIL bridging protocol with tirofiban, and later they were considered potential candidates for angioplasty and stent placement bailout (43.2%, intra-arterial SAIL). Post-SAIL successful reperfusion was obtained in 79.5%. A notable residual stenosis (>50%) after successful SAIL was observed in 45.7%. No significant differences were detected according to post-SAIL: successful reperfusion (intra-arterial SAIL, 80.0% versus IV-SAIL, 78.9%; P = .932), significant stenosis (33.3% versus 55.0%; P = .203), early symptomatic re-occlusion (0% versus 8.0%; P = .207), or symptomatic intracerebral hemorrhage (5.3% versus 8.0%; P = .721). Rescue angioplasty and stent placement were finally performed in 15 (34.1%) patients (intra-arterial SAIL 21.0% versus IV-SAIL 44%; P = .112). At 90 days, mRS 0-2 (intra-arterial SAIL 50.0% versus IV-SAIL 43.5%; P = .086) and mortality (26.3% versus 12.0%; P = .223) were also similar. CONCLUSIONS In patients with stroke in which angioplasty and stent placement are considered, SAIL with tirofiban, either intra-arterial or IV, seems to safely induce sustained recanalization, offering a potential alternative to definitive angioplasty and stent placement.
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Affiliation(s)
- Marc Rodrigo-Gisbert
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matúš Hoferica
- Department of Diagnostic Neuroradiology (M.H., C.C.), Hôpital Purpan, Centre Hospitalier Universitaire, Toulouse, France
| | - Alvaro García-Tornel
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Requena
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marta Rubiera
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta De Dios Lascuevas
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marta Olivé-Gadea
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesco Diana
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Federica Rizzo
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marian Muchada
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomás Carmona
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Noelia Rodriguez-Villatoro
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Rodríguez-Luna
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesus Juega
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Pagola
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Hernández
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos A Molina
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Tomasello
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Christophe Cognard
- Department of Diagnostic Neuroradiology (M.H., C.C.), Hôpital Purpan, Centre Hospitalier Universitaire, Toulouse, France
| | - Marc Ribó
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
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Sun Z, Huang S, Li W, Yang Y, Wu Y, Ma X, Nie X, Jin W, Liu C, Li X, Xu Y, Dong J, Liao Y, Sun B, Han W, Zhao Q, Chi H, Wang Y, Liu L, Zhang M. Preoperative and intraoperative tirofiban during endovascular thrombectomy in large vessel occlusion stroke due to large artery atherosclerosis. Eur J Neurol 2024:e16419. [PMID: 39072930 DOI: 10.1111/ene.16419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/27/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND PURPOSE The aim of this study is to investigate the efficacy and safety of preoperative versus intraoperative tirofiban in patients with large vessel occlusion (LVO) due to large artery atherosclerosis (LAA). METHODS This is a retrospective multicenter cohort study based on the RESCUE-RE (Registration Study for Critical Care of Acute Ischemic Stroke After Recanalization) trial enrolling patients with anterior circulation LVO classified as LAA within 24 h of onset. Patients were divided into three groups: preoperative tirofiban (PT), intraoperative tirofiban (IT), and no tirofiban (NT). Propensity score matching (PSM) was used to balance baseline characteristics. The efficacy outcomes included 90-day functional independence (modified Rankin Scale score = 0-2) and early partial recanalization (EPR; defined as a modified Thrombolysis in Cerebral Infarction score = 1-2a). The safety outcomes included symptomatic intracranial hemorrhage (sICH). RESULTS A total of 104 matched triplets were obtained through PSM. Compared with NT, PT increased 90-day functional independence (60.8% vs. 42.3%, p = 0.008) and EPR (42.7% vs. 18.3%, p < 0.001) rate, with a tendency to increase the asymptomatic intracranial hemorrhage (aICH) proportion (28.8% vs. 18.3%, p = 0.072). Compared with IT, PT had a higher 90-day functional independence (60.8% vs. 45.2%, p = 0.025) and EPR (42.7% vs. 20.2%, p = 0.001) rate, with no significant difference in sICH (14.4% vs. 7.7%, p = 0.122) and aICH (28.8% vs. 21.2%, p = 0.200). Compared with NT, IT had a lower 90-day mortality rate (9.6% vs. 24.0%, p = 0.005). CONCLUSIONS Tirofiban shows good adjuvant therapy potential in acute ischemic stroke-LVO due to LAA patients. PT is associated with higher rates of EPR and better therapeutic efficacy. In addition, EPR may be a potential way to improve prognosis.
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Affiliation(s)
- Zhiqiang Sun
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Shuhan Huang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Li
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yi Yang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ya Wu
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xue Ma
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ximing Nie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wangsheng Jin
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Chengchun Liu
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xiaoshu Li
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yaning Xu
- Department of Neurology, 985 Hospital of Joint Logistics Support Force, Taiyuan, China
| | - Jun Dong
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yisi Liao
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Binlu Sun
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Wenjun Han
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Qing Zhao
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Huaqiao Chi
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yanjiang Wang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Meng Zhang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
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Liu X, He W, Li M, Yang J, Huang J, Kong W, Guo C, Hu J, Liu S, Yang D, Song J, Peng Z, Li L, Tian Y, Zi W, Yue C, Li F. Predictors of outcome in large vessel occlusion stroke patients with intravenous tirofiban treatment: a post hoc analysis of the RESCUE BT clinical trial. BMC Neurol 2024; 24:227. [PMID: 38956505 PMCID: PMC11218210 DOI: 10.1186/s12883-024-03733-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 06/17/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE The aim of this study was to investigate the factors influencing good outcomes in patients receiving only intravenous tirofiban with endovascular thrombectomy for large vessel occlusion stroke. METHODS Post hoc exploratory analysis using the RESCUE BT trial identified consecutive patients who received intravenous tirofiban with endovascular thrombectomy for large vessel occlusion stroke in 55 comprehensive stroke centers from October 2018 to January 2022 in China. RESULTS A total of 521 patients received intravenous tirofiban, 253 of whom achieved a good 90-day outcome (modified Rankin Scale [mRS] 0-2). Younger age (adjusted odds ratio [aOR]: 0.965, 95% confidence interval [CI]: 0.947-0.982; p < 0.001), lower serum glucose (aOR: 0.865, 95%CI: 0.807-0.928; p < 0.001), lower baseline National Institutes of Health Stroke Scale (NIHSS) score (aOR: 0.907, 95%CI: 0.869-0.947; p < 0.001), fewer total passes (aOR: 0.791, 95%CI: 0.665-0.939; p = 0.008), shorter punctures to recanalization time (aOR: 0.995, 95%CI:0.991-0.999; p = 0.017), and modified Thrombolysis in Cerebral Infarction (mTICI) score 2b to 3 (aOR: 8.330, 95%CI: 2.705-25.653; p < 0.001) were independent predictors of good outcomes after intravenous tirofiban with endovascular thrombectomy for large vessel occlusion stroke. CONCLUSION Younger age, lower serum glucose level, lower baseline NIHSS score, fewer total passes, shorter punctures to recanalization time, and mTICI scores of 2b to 3 were independent predictors of good outcomes after intravenous tirofiban with endovascular thrombectomy for large vessel occlusion stroke. CHINESE CLINICAL TRIAL REGISTRY IDENTIFIER ChiCTR-IOR-17014167.
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Affiliation(s)
- Xiang Liu
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China
| | - Wencheng He
- Department of Neurology, Guangxi Guiping People's Hospital, Guiping, Guangxi, China
| | - Meiqiong Li
- Department of Neurology, Guangxi Guiping People's Hospital, Guiping, Guangxi, China
| | - Jie Yang
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China
| | - Jiacheng Huang
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China
| | - Weilin Kong
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China
| | - Changwei Guo
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China
| | - Jinrong Hu
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China
| | - Shuai Liu
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China
| | - Dahong Yang
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China
| | - Jiaxing Song
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China
| | - Zhouzhou Peng
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China
| | - Linyu Li
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China
| | - Yan Tian
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China
| | - Wenjie Zi
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China
| | - Chengsong Yue
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China.
| | - Fengli Li
- Department of Neurology, The Second Affiliated Hospital, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, 400037, China.
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Li S, Zhang D, Sha Y, Zhu Y, Zhou L, Peng B, Ni J. Efficacy and safety of tirofiban in patients with acute branch atheromatous disease-related stroke (BRANT): a protocol for a randomised controlled trial. BMJ Open 2024; 14:e082141. [PMID: 38858147 PMCID: PMC11168161 DOI: 10.1136/bmjopen-2023-082141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/09/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION Branch atheromatous disease (BAD)-related stroke is increasingly becoming a clinical entity and prone to early neurological deterioration (END) and poor prognosis. There are no effective regimens to reduce the disability caused by BAD-related stroke in acute phase. Recent studies have indicated the efficacy of tirofiban in acute ischaemic stroke; however, its efficacy has not been validated in patients with BAD-related stroke. Thus, we aim to test whether intravenous tirofiban initiated within 48 hours after the onset would improve the functional outcome in patients with acute BAD-related stroke, in comparison with the standard antiplatelet therapy based on the current guideline. METHODS AND ANALYSIS BRANT is a multicentre, randomised, open-label, blinded endpoint, parallel-controlled, phase III trial conducted in 21 hospitals in China. Participants aged 18-75 years with acute BAD-related stroke within 48 hours after the stroke onset are randomised in a 1:1 ratio to the tirofiban or control group. The treatment period is 48 hours in both groups. The primary outcome is the excellent functional outcome (modified Rankin Scale Score: 0-1) at 90 days. The secondary outcomes include END, major bleeding, stroke, death, functional status, serious adverse events and change in bleeding-related markers. Assuming the rates of the primary outcome to be 74% in the tirofiban group and 62% in the control group, a total of 516 participants are needed for 0.8 power (two-sided 0.05 alpha). ETHICS AND DISSEMINATION BRANT study has been approved by the Ethics Committee of the Peking Union Medical College Hospital (I-23PJ1242). Written informed consent is required for all the patients before enrolment. The results of the study will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT06037889).
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Affiliation(s)
- Shengde Li
- Department of neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dingding Zhang
- Medical Research Center, State Key laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuhui Sha
- Department of neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yicheng Zhu
- Department of neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lixin Zhou
- Department of neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bin Peng
- Department of neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jun Ni
- Department of neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Li H, Ju D, Tao Z, Wang J, Nguyen TN, Saver JL, Nogueira RG, Liu C, Yang Q, Qiu Z, Yin C, Sun D, Liu S. Adjunct Intraarterial or Intravenous Tirofiban Versus No Tirofiban After Successful Recanalization of Basilar Artery Occlusion Stroke: The BASILAR Registry. J Am Heart Assoc 2024; 13:e032326. [PMID: 38390817 PMCID: PMC10944024 DOI: 10.1161/jaha.123.032326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Approximately half of patients who achieve successful reperfusion do not achieve functional independence. The present study sought to investigate the clinical outcomes and safety of intraarterial or intravenous tirofiban as adjunct therapy in patients with acute basilar artery occlusion who had achieved successful recanalization with endovascular treatment. METHODS AND RESULTS In the national, prospective BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study) registry, 458 patients who met inclusion criteria were divided into 3 groups based on tirofiban administration (no tirofiban, n=262; intravenous tirofiban, n=101; intraarterial+intravenous tirofiban, n=95). Their clinical outcomes were compared with 90-day modified Rankin Scale scores. Adjusted odds ratios (aORs) and 95% CIs were obtained by logistic regression models and propensity score matching. Safety outcomes included any intracranial hemorrhage (ICH), symptomatic ICH, and mortality. Among 458 included patients, 184 (40.2%) achieved a favorable outcome (modified Rankin Scale score 0-3). There were no differences between the intravenous tirofiban group and the no tirofiban group in terms of safety and clinical outcomes (all P>0.05). Compared with the no tirofiban group, the intraarterial+intravenous tirofiban group had higher odds of 90-day modified Rankin Scale score 0 to 3 (aOR, 2.44 [95% CI, 1.30-4.64], P=0.006) and lower 3-month mortality (aOR, 0.38 [95% CI, 0.19-0.71], P=0.002) without an increase in any ICH (aOR, 0.34 [95% CI, 0.09-1.01], P=0.07) or symptomatic ICH (aOR, 0.23 [95% CI, 0.03-0.90], P=0.05). Similar results of intraarterial+intravenous tirofiban on improving clinical outcomes were detected in novel cohorts constructed by propensity score matching. CONCLUSIONS Intraarterial+intravenous rather than intravenous tirofiban improved clinical outcomes without increasing the frequency of symptomatic ICH among patients with basilar artery occlusion after successful endovascular treatment. Further studies are needed to delineate the roles of intraarterial+intravenous tirofiban in patients with basilar artery occlusion receiving endovascular treatment.
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Affiliation(s)
- Huagang Li
- Department of Neurology, Zhongnan HospitalWuhan UniversityWuhanChina
| | - Dongsheng Ju
- Department of NeurologySongyuan Jilin Oilfield HospitalSongyuanChina
| | - Zhaojun Tao
- Department of NeurologyThe 903rd Hospital of The People’s Liberation ArmyHangzhouChina
| | - Jiayin Wang
- Department of NeurologyThe 903rd Hospital of The People’s Liberation ArmyHangzhouChina
| | - Thanh N. Nguyen
- Department of Neurology and RadiologyBoston Medical CenterBostonMAUSA
| | - Jeffrey L. Saver
- Department of NeurologyDavid Geffen School of Medicine at University of California at Los AngelesLos AngelesCAUSA
| | - Raul G. Nogueira
- Department of Neurology, UPMC Stroke InstituteUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Chang Liu
- Department of NeurologyXinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University)ChongqingChina
| | - Qingwu Yang
- Department of NeurologyXinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University)ChongqingChina
| | - Zhongming Qiu
- Department of NeurologyThe 903rd Hospital of The People’s Liberation ArmyHangzhouChina
- Department of NeurologyXinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University)ChongqingChina
| | - Congguo Yin
- Department of Neurology, Affiliated Hangzhou First People’s HospitalZhejiang University School of MedicineHangzhouChina
| | - Dong Sun
- Department of Neurology, Zhongnan HospitalWuhan UniversityWuhanChina
| | - Shudong Liu
- Department of NeurologyYongchuan Hospital of Chongqing Medical University, Chongqing Key Laboratory of Cerebrovascular Disease ResearchChongqingChina
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Bu Z, Sun D, Ma G, Jia B, Tong X, Huo X, Wang A, Ma N, Gao F, Mo D, Song L, Sun X, Deng Y, Li X, Wang B, Luo G, Su D, Miao Z. The impact of intraarterial, intravenous, and combined tirofiban on endovascular treatment for acute intracranial atherosclerotic occlusion. Front Neurol 2024; 15:1336098. [PMID: 38414555 PMCID: PMC10896834 DOI: 10.3389/fneur.2024.1336098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Abstract
Background and purpose Adjunctive tirofiban administration in patients undergoing endovascular treatment (EVT) for acute large vessel occlusion (LVO) has been investigated in several studies. However, the findings are conflict. This study aimed to compare the effect of different administration pathways of tirofiban on patients undergoing EVT for acute LVO with intracranial atherosclerotic disease (ICAD). Methods Patients were selected from the ANGEL-ACT Registry (Endovascular Treatment Key Technique and Emergency Workflow Improvement of Acute Ischemic Stroke: A Prospective Multicenter Registry Study) and divided into four groups: intra-arterial (IA), intravenous (IV), and intra-arterial plus intravenous (IA+IV) and non-tirofiban. The primary outcome was 90-day ordinal modified Rankin Scale (mRS) score, and the secondary outcomes included the rates of mRS 0-1, 0-2, and 0-3 at 90-day, successful recanalization. The safety outcomes were symptomatic intracranial hemorrhage (sICH) and other safety endpoints. The multivariable logistic regression models adjusting for potential baseline confounders were performed to compare the outcomes. A propensity score matching (PSM) with a 1:1:1:1 ratio was conducted among four groups, and the outcomes were then compared in the post-matched population. Results A total of 502 patients were included, 80 of which were in the IA-tirofiban group, 73 in IV-tirofiban, 181 in (IA+IV)-tirofiban group, and 168 in the non-tirofiban group. The median (IQR) 90-day mRS score in the four groups of IA, IV, IA+IV, and non-tirofiban was, respectively 3(0-5) vs. 1(0-4) vs. 1(0-4) vs. 3(0-5). The adjusted common odds ratio (OR) for 90-day ordinal modified Rankin Scale distribution with IA-tirofiban vs. non-tirofiban was 0.77 (95% CI, 0.45-1.30, P = 0.330), with IV-tirofiban vs. non-tirofiban was 1.36 (95% CI, 0.78-2.36, P = 0.276), and with (IA+IV)-tirofiban vs. non-tirofiban was 1.03 (95% CI, 0.64-1.64, P = 0.912). The adjusted OR for mRS 0-1 and mRS 0-2 at 90-day with IA-tirofiban vs. non-tirofiban was, respectively 0.51 (95% CI, 0.27-0.98, P = 0.042) and 0.50 (95% CI, 0.26-0.94, P = 0.033). The other outcomes of each group were similar with non-tirofiban group, all P was >0.05. After PSM, the common odds ratio (OR) for 90-day ordinal modified Rankin Scale distribution with IA-tirofiban vs. non-tirofiban was 0.41 (95% CI, 0.18-0.94, P = 0.036), and the OR for mRS 0-1 and mRS 0-2 at 90-day with IA-tirofiban vs. non-tirofiban was, respectively 0.28 (95% CI, 0.11-0.74, P = 0.011) and 0.25 (95% CI, 0.09-0.67, P = 0.006). Conclusions Intra-arterial administration of tirofiban was associated with worse outcome than non-tirofiban, which suggested that intra-arterial tirofiban had a harmful effect on patients undergoing EVT for ICAD-LVO. Clinical trial registration http://www.clinicaltrials.gov, Unique identifier: NCT03370939.
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Affiliation(s)
- Zhiping Bu
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Sun
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gaoting Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Baixue Jia
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Huo
- Cerebrovascular Disease Department, Neurological Disease Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ligang Song
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuan Sun
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yiming Deng
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoqing Li
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo Wang
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gang Luo
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Deguo Su
- Department of Neurology, Liangxiang Hospital of Beijing Fangshan District, Beijing, China
| | - Zhongrong Miao
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Cho KC, Son NH, Gwon SH, Choi JW, Jung WS. The safety and efficacy of intra-arterial low-dose tirofiban administration during endovascular therapy in patients with large ischemic core volume. Sci Rep 2024; 14:3353. [PMID: 38336813 PMCID: PMC10858233 DOI: 10.1038/s41598-024-53715-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/04/2024] [Indexed: 02/12/2024] Open
Abstract
This study aimed to evaluate the safety and efficacy of intra-arterial (IA) administration of low- dose tirofiban during endovascular therapy in patients with large ischemic core volumes on initial brain CT. Patients were divided into two groups based on the use of IA tirofiban. We identified 87 patients (16 and 71 patients in the tirofiban and no-tirofiban groups, respectively) with acute ischemic stroke due to intracranial artery occlusion who underwent endovascular therapy with a low Alberta Stroke Program Early CT scores (2-5). Multivariate logistic regression analysis revealed no association between IA tirofiban administration and serious postprocedural hemorrhagic complications (adjusted odds ratio (aOR), 0.720; 95% confidence interval (CI) 0.099-5.219; p = 0.960), any radiologic hemorrhage (aOR 0.076; 95% CI 0.003-2.323; p = 0.139), or 3-month mortality (aOR, 0.087; 95% CI 0.005-1.501; p = 0.093). However, IA tirofiban was associated with a lower 90-day mRS score (aOR, 0.197; 95% CI 0.015-1.306; p = 0.017) and change of NIHSS compared with baseline (aOR, 0.698; 95% CI 0.531-0.917; p = 0.010). IA tirofiban administration during endovascular therapy in patients with large ischemic core volumes may be effective and safe.
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Affiliation(s)
- Kwang-Chun Cho
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Nak-Hoon Son
- Department of Statistics, Keimyung University, Daegu, South Korea
| | - So Hyeon Gwon
- Department of Statistics, Keimyung University, Daegu, South Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University Hospital, Ajou University College of Medicine, 164, World Cup-Ro, Yeongtong-Gu, Suwon, 16499, South Korea
| | - Woo Sang Jung
- Department of Radiology, Ajou University Hospital, Ajou University College of Medicine, 164, World Cup-Ro, Yeongtong-Gu, Suwon, 16499, South Korea.
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8
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Zhu X, Guo Z, Tian L, Zeng G, Zhou P, Yuan Z, Sang H, Qiu Z, Yang Q, Wu Y, Li J. Efficacy and safety of tirofiban combined with endovascular therapy for basilar artery occlusion stroke due to large artery atherosclerosis. J Stroke Cerebrovasc Dis 2024; 33:107526. [PMID: 38096657 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the efficacy and safety of adjuvant tirofiban in patients with acute basilar artery occlusion due to large-artery atherosclerotic (LAA) receiving endovascular therapy (EVT). METHODS This was a non-randomized, multicenter study using data from the Endovascular Treatment for Acute BASILAR Artery Occlusion (BASILAR) registry. Patients with acute basilar artery occlusion due to LAA within 24h of symptom onset who underwent EVT were included. Patients were divided into tirofiban and non-tirofiban groups according to whether tirofiban was used. The primary outcome was the ordinal modified Rankin scale score at 90 days. Safety outcomes were mortality within 90 days and symptomatic intracranial hemorrhage (sICH) within 48 h. RESULTS A total of 417 patients were included, of whom 275 patients were in the tirofiban group and 142 patients in the non-tirofiban group. Compared with patients in the non-tirofiban group, patients in the tirofiban group were associated with a favorable shift in functional outcome at 90 days (6[4-6] vs 5 [2-6]; adjusted common OR, 2.51; 95 % CI, 1.64-3.83). The mortality was lower in the tirofiban group than the non-tirofiban group (40.7 % vs 58.5 %; adjusted OR, 0.35; 95 % CI, 0.21-0.56). The rate of sICH was 12.2 % in the non-tirofiban group and 5.2 % in the tirofiban group (adjusted OR, 0.37; 95 % CI, 0.17-0.80; P = 0.012). CONCLUSION Tirofiban plus EVT might improve functional outcomes with a good safety for patients with acute basilar artery occlusion due to LAA. The results need to be confirmed in a randomized trial.
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Affiliation(s)
- Xiurong Zhu
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China; Department of Neurology, Chongzhou People's Hospital, Chongzhou 611230, China
| | - Zhangbao Guo
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan 430000, China
| | - Ling Tian
- Department of Neurology, Yuhuangding Hospital, Qingdao University, Yantai 264000, China
| | - Guoyong Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou 341000, China
| | - Peiyang Zhou
- Department of Neurology, The First People's Hospital of Xiangyang, Hubei Medical University, Xiangyang 441000, China
| | - Zhengzhou Yuan
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Hongfei Sang
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
| | - Zhongming Qiu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China
| | - Youlin Wu
- Department of Neurology, Chongzhou People's Hospital, Chongzhou 611230, China
| | - Jinglun Li
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.
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Zhang Y, Zhang P, Tao A, Wang X, Ying J, Wang Z, Yang P, Zhang Y, Zhang L, Li Z, Zhang M, Xu C, Liu J. The Efficacy and Safety of Tirofiban Use in Endovascular Thrombectomy for Intravenous Thrombolysis Applicable Patients with Large Vessel Occlusion Stroke-a Post Hoc Analysis from the Direct-MT Trial. Cardiovasc Intervent Radiol 2024; 47:208-215. [PMID: 37798430 PMCID: PMC10844137 DOI: 10.1007/s00270-023-03540-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/13/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the efficacy and safety of tirofiban use in endovascular thrombectomy for intravenous thrombolysis applicable patients of large vessel occlusion stroke with data from Direct-MT trial. MATERIALS AND METHODS Direct-MT was the first randomized controlled trial to prove the non-inferiority of thrombectomy alone to bridging therapy (intravenous thrombolysis before thrombectomy) for large vessel occlusion stroke. Patients who underwent endovascular procedure were included and divided into thrombectomy-alone group and bridging therapy group. The effect of tirofiban use on 90 days MRS distribution, MRS 0-2 and mortality, successful reperfusion, the ASPECTS and outcome lesion volume of index stroke, re-occlusion of the treated vessel, futile recanalization and safety outcomes were further evaluated in both groups after adjustment for relevant confounding factors. The interaction between tirofiban and rt-PA was also assessed. RESULTS Of 639 patients included in this analysis, 180 patients underwent thrombectomy with tirofiban use (28.2%). Patients with tirofiban use had lower percentage of bridging therapy (41.1% vs 54.3%, P = 0.003), higher proportion of large artery atherosclerosis (P < 0.001) and more emergent stenting (30.56% vs 6.97%, P < 0.001). After adjustment for confounding factors, the 90-day modified Rankin Scale distribution, successful final recanalization rate, outcome lesion volume of index stroke on CT and intracranial hemorrhage risk showed no difference after tirofiban use in thrombectomy-alone group and in bridging therapy group. No interaction effect between tirofiban and rt-PA was detected. CONCLUSION Based on data from Direct-MT trial, tirofiban is a safe medication for intravenous thrombolysis applicable patients with large vessel occlusion stroke undergoing thrombectomy. LEVEL OF EVIDENCE Level 3, cohort study of randomized trial.
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Affiliation(s)
- Yingying Zhang
- Department of Neurology, Fudan University Zhongshan Hospital, Shanghai, China
| | - Ping Zhang
- Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
- Department of Neurology, Naval Medical University Naval Medical Center of PLA, Shanghai, China
| | - Anyang Tao
- Department of Neurology, Taizhou First People's Hospital, 218 Hengjie Road, Taizhou, 318020, Zhejiang, China
| | - Xinliang Wang
- Department of Neurology, Taizhou First People's Hospital, 218 Hengjie Road, Taizhou, 318020, Zhejiang, China
| | - Jiangxian Ying
- Department of Neurology, Taizhou First People's Hospital, 218 Hengjie Road, Taizhou, 318020, Zhejiang, China
| | - Zhimin Wang
- Department of Neurology, Taizhou First People's Hospital, 218 Hengjie Road, Taizhou, 318020, Zhejiang, China
| | - Pengfei Yang
- Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Yongwei Zhang
- Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Lei Zhang
- Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Zifu Li
- Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Meng Zhang
- Department of Neurosurgery, Liaocheng People's Hospital of Shandong First Medical University, 67 West Dongchang Road, Liaocheng, 252200, Shandong, China.
| | - Chenghua Xu
- Department of Neurology, Taizhou First People's Hospital, 218 Hengjie Road, Taizhou, 318020, Zhejiang, China.
| | - Jianmin Liu
- Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
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Brake A, Heskett C, Alam N, Fry L, Le K, Mahnken JD, Abraham M. Glycoprotein inhibitors as a first line rescue treatment after unsuccessful recanalization of endovascular thrombectomy: A systematic review and meta-analysis. Interv Neuroradiol 2024:15910199241226470. [PMID: 38204180 DOI: 10.1177/15910199241226470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Intracranial atherosclerotic disease (ICAD) is a major cause of stroke with a high rate of re-occlusion following mechanical thrombectomy (MT). Among the available rescue options, glycoprotein IIb/IIIa inhibitors (GPI) have shown promise as a potential therapeutic strategy. This systematic review and meta-analysis examine studies exploring the use of glycoprotein inhibitors as a first-line treatment for refractory occlusion or high-grade stenosis following EVT in the setting of ICAD. METHODS A systematic review and meta-analysis were performed. Studies using GPI as the first-line rescue treatment (GPI-rt) after failed thrombectomy or in the setting with high-grade stenosis (>50%) were included. The primary outcome of interest was good clinical outcomes (defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days). Secondary outcomes of interest were successful recanalization (TICI 2b-3), symptomatic intracranial hemorrhage (sICH), and mortality by 90 days. RESULTS Our study processed 2111 articles, which yielded eight relevant studies for review, four single and four double arm. These studies comprised 763 patients, divided into GPI-rt (535 patients) and non-GPI-rt (228 patients) cohorts. The GPI-rt group had higher rates of mRS ≤ 2 at 90 days (58.5% vs 38.9%, p = 0.002) and lower mortality rates (7.8% vs 17.5%, p = 0.04) compared to the non-GPI-rt cohort. mTICI 2b-3 rates and rates of sICH were not significantly different between the cohorts. CONCLUSIONS First line GPI-rt demonstrates significant clinical benefit and significantly lower mortality without a rise in rates of sICH. GPI are a potential first line rescue treatment of ICAD.
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Affiliation(s)
- Aaron Brake
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Cody Heskett
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Naima Alam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lane Fry
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Kevin Le
- University of Kansas School of Medicine, Kansas City, KS, USA
| | - Jonathan D Mahnken
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michael Abraham
- Department of Neurology, University of Kansas Health System, Kansas City, KS, USA
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Xie H, Chen Y, Ge W, Xu X, Liu C, Lan Z, Yang Y. Does Endovascular Thrombectomy(ET) plus tirofiban benefit stroke patients: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2024; 33:107494. [PMID: 38035642 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Ischemic stroke is the second leading cause of death worldwide. Endovascular thrombectomy (ET) has been shown to prevent disability in a proportion of patients. The use of tirofiban in patients undergoing ET after acute stroke has resulted in improved patient function and reduced mortality to some extent. In this systematic review and meta-analysis of the current period, an overview of the most recent studies on the potential efficacy of using tirofiban to help acute stroke patients improve function and reduce mortality was provided. METHODS In this meta-analysis, we explore the safety and efficacy of ET combined with tirofiban in patients with acute stroke. We searched the PubMed, EMBASE, Web of Science, and The Cochrane Library database from the construction of the library to the present relevant RCTs/non-RCTs. The following key words were used for finding relevant studies from the databases"tirofiban""thrombectomy"" Stroke"" balloon angioplasty""stenting". RESULTS Total of 14 trials with 4366 individuals enrolled were included in the Meta-analysis including 2732(62.6) who received ET alone and 1634(37.4 %) who received tirofiban plus ET. The primary outcome of 90-day functional independence (modified Rankin scale (mRS) score≤2) was 42.2 % (1043/2473) in the ET alone group vs. 46.2 % (684/1480) in the tirofiban with ET group (risk ratio (RR), 1.10 [95 % CI, 1.02-1.18]; P=0.02),mortality at 90 days (RR, 0.86 [95 % CI, 0.76-0.98]; P = 0.02). There is no significant between-group differences were found in excellent outcome (mRS score ≤1) (RR, 1.08 [95 % CI, 0.95-1.23]; P = 0.22), symptomatic intracranial hemorrhage (RR, 1.11 [95 % CI, 0.92-1.34]; P = 0.27). CONCLUSIONS These findings suggest that the use of ET combined with tirofiban in patients with acute stroke is safe and has the potential to reduce mortality and improve functional independence at 90 days.
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Affiliation(s)
- Haiyan Xie
- Department of clinical Pharmacy, The Third Hospital of Quzhou, Quzhou, Zhejiang 324003, China
| | - Ying Chen
- Hangzhou Fuyang Hospital of traditional Chinese Medicine, Zhejiang 311400, China
| | - Wukun Ge
- Department of clinical Pharmacy, Ninghai First Hospital, Zhejiang 315600, China
| | - Xiuping Xu
- Department of Emergency Medicine, The Third Hospital of Quzhou, Quzhou, Zhejiang 324003, China.
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People's Hospital of Anhui Medical University, 246000, China
| | - Zhiyong Lan
- Department of Psychiatry Department, The Third Hospital of Quzhou, Quzhou, Zhejiang 324003, China
| | - Yina Yang
- Department of Neurology, Ninghai First Hospital, Zhejiang 315600, China
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Charbonnier G, Consoli A, Bonnet L, Biondi A, Vuillier F, Rabenorosoa K, Mendes Pereira V, Moulin T. Telestroke network to robotic telestroke network: How to upgrade regional stroke care to include remote robotics? Digit Health 2024; 10:20552076241254986. [PMID: 38766366 PMCID: PMC11100382 DOI: 10.1177/20552076241254986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Abstract
Objective Selected patients with large vessel occlusion (LVO) strokes can benefit from endovascular therapy (EVT). However, the effectiveness of EVT is largely dependent on how quickly the patient receives treatment. Recent technological developments have led to the first neurointerventional treatments using robotic assistance, opening up the possibility of performing remote stroke interventions. Existing telestroke networks provide acute stroke care, including remote administration of intravenous thrombolysis (IVT). Therefore, the introduction of remote EVT in distant stroke centers requires an adaptation of the existing telestroke networks. The aim of this work was to propose a framework for centers that are potential candidates for telerobotics according to the resources currently available in these centers. Methods In this paper, we highlight the future challenges for including remote robotics in telestroke networks. A literature review provides potential solutions. Results Existing telestroke networks need to determine which centers to prioritize for remote robotic technologies based on objective criteria and cost-effectiveness analysis. Organizational challenges include regional coordination and specific protocols. Technological challenges mainly concern telecommunication networks. Conclusions Specific adaptations will be necessary if regional telestroke networks are to include remote robotics. Some of these can already be put in place, which could greatly help the future implementation of the technology.
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Affiliation(s)
- Guillaume Charbonnier
- CHU Besançon, Interventional Neuroradiology Department, Besançon, France
- CHU Besançon, Neurology Department, Besançon, France
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive - UMR INSERM 1322, Université de Franche-Comté, Besançon, France
| | - Arturo Consoli
- Interventional Neuroradiology Department, Hôpital Foch, Paris, France
| | - Louise Bonnet
- CHU Besançon, Neurology Department, Besançon, France
| | - Alessandra Biondi
- CHU Besançon, Interventional Neuroradiology Department, Besançon, France
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive - UMR INSERM 1322, Université de Franche-Comté, Besançon, France
| | - Fabrice Vuillier
- CHU Besançon, Neurology Department, Besançon, France
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive - UMR INSERM 1322, Université de Franche-Comté, Besançon, France
| | | | - Vitor Mendes Pereira
- St. Michael's Hospital Li Ka Shing Knowledge Institute, RADIS Lab, Toronto, ON, Canada
- Department of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Thierry Moulin
- CHU Besançon, Neurology Department, Besançon, France
- Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive - UMR INSERM 1322, Université de Franche-Comté, Besançon, France
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Rong B, Guo Z, Gao L, Yang Y, Zi W, Qiu Z, Li F, Lv Z, Luo Y, Meng R, Xie Y, Long T, Zhang S, Jiang J, Tian J, Zhao J, Zeng H, Yuan Z. Association of tirofiban treatment with outcomes following endovascular therapy in cardioembolic stroke: insights from the RESCUE BT randomized trial. Eur J Med Res 2023; 28:473. [PMID: 37915101 PMCID: PMC10621173 DOI: 10.1186/s40001-023-01406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND AND PURPOSE The efficacy and safety of tirofiban in endovascular therapy for cardioembolic ischemic stroke patients remain controversial. This study aimed to evaluate the role of intravenous tirofiban before endovascular therapy in cardioembolic stroke. METHODS This post hoc analysis utilized data from the RESCUE BT (Endovascular Treatment With versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke) trial, which was an investigator-initiated, randomized, double-blind, placebo-controlled trial. Participants were randomized to receive either tirofiban or a placebo in a 1:1 ratio before undergoing endovascular therapy. The study included patients aged 18 years or older, presenting with occlusion of the internal carotid artery or middle cerebral artery (MCA) M1/M2 within 24 h of the last known well time, and with a stroke etiology of cardioembolism. The primary efficacy outcome was global disability at 90 days, assessed using the modified Rankin Scale (mRS). The safety outcome included symptomatic intracranial hemorrhage (sICH) within 48 h and mortality within 90 days. RESULTS A total of 406 cardioembolic stroke patients were included in this study, with 212 assigned to the tirofiban group and 194 assigned to the placebo group. Tirofiban treatment did not correlate with a favorable shift towards a lower 90-day mRS score (adjusted common odds ratio [OR], 0.91; 95% CI 0.64-1.3; p = 0.617). However, the tirofiban group had a significantly higher risk of symptomatic intracranial hemorrhage (sICH) within 48 h (adjusted OR, 3.26; 95% CI 1.4-7.57; p = 0.006) compared to the placebo group. The adjusted odds ratio (aOR) for mortality within 90 days was 1.48 (95% CI 0.88-2.52; p = 0.143). CONCLUSIONS Tirofiban treatment was not associated with a lower level of disability and increased the incidence of sICH after endovascular therapy in cardioembolic stroke patients.
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Affiliation(s)
- Benbing Rong
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhangbao Guo
- Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China
| | - Lijie Gao
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yuan Yang
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhongming Qiu
- Department of Neurology, The 903Rd Hospital of The Chinese People's Liberation Army, Hangzhou, China
| | - Fengli Li
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhiyu Lv
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ying Luo
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Renliang Meng
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yang Xie
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ting Long
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shujiang Zhang
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jinshan Jiang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Jinfeng Tian
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Jingling Zhao
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Hongliang Zeng
- Department of Neurology, Ganzhou People's Hospital, Zhanggong District, 17 Hongqi Avenue, Ganzhou, China.
| | - Zhengzhou Yuan
- Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
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14
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Chang Y, Li YZ, Xue L. Adjuvant intra-arterial thrombolysis during mechanical thrombectomy is an effective means of improving outcomes for patients with large vessel occlusion stroke: A systematic review and meta-analysis. Clin Neurol Neurosurg 2023; 232:107898. [PMID: 37473487 DOI: 10.1016/j.clineuro.2023.107898] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 06/30/2023] [Accepted: 07/15/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE It is unknown whether adjunctive intra-arterial thrombolysis (IAT) during mechanical thrombectomy (MT) improves outcomes in patients with large vessel occlusion (LVO) stroke. This systematic review and meta-analysis aimed to compare the safety and efficacy of MT with and without IAT for the treatment of LVO stroke. METHODS A systematic literature search of PubMed, Embase, and the Cochrane Library was conducted to identify studies that compared rates of 3-month functional independence (modified Rankin Scale score 0-2), successful revascularization, symptomatic intracranial hemorrhage, and 3-month mortality for MT+IAT and MT alone. Meta-analyses were performed using random effects models, and effect sizes were expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Heterogeneity was assessed with Cochran's Q test and I2 statistic. RESULTS Twelve studies met eligibility criteria, comprising one randomized controlled trial and 11 observational cohort studies involving 2584 patients. Compared to MT alone, MT+IAT had a 43% higher odds of 3-month functional independence (OR 1.43, 95% CI 1.11-1.83; I2 =21%) and a 23% decrease in odds for 3-month mortality (OR 0.77, 95% CI 0.60-0.99; I2 =0%). There were no differences in successful revascularization (OR 1.39, 95% CI 0.89-2.17; I2 =57%) or symptomatic intracranial hemorrhage (OR 0.87, 95% CI 0.56-1.35; I2 =6%) between the two groups. CONCLUSIONS The present study has demonstrated that, compared with MT alone, the use of adjunct IAT during MT in patients with LVO stroke resulted in better functional outcomes and lower mortality.
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Affiliation(s)
- Yu Chang
- Department of Neurology, Suining Central Hospital, Sichuan, China.
| | - Yi-Zheng Li
- Department of Neurology, Qinghai Provincial People's Hospital, Qinghai, China
| | - Lin Xue
- Department of Neurology, The First Hospital of Jilin University, Jinlin, China
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15
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Lin CJ, Chung CP, Liao NC, Chen PL, Chi NF, Lai YJ, Tang CW, Wu CH, Chang FC, Luo CB, Fay LY, Lin CF, Chou CH, Lee TH, Lee JT, Jeng JS, Lee IH. The 2023 Taiwan Stroke Society Guidelines for the management of patients with intracranial atherosclerotic disease. J Chin Med Assoc 2023; 86:697-714. [PMID: 37341526 DOI: 10.1097/jcma.0000000000000952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke, especially in Asian populations, which has a high risk of recurrent stroke and cardiovascular comorbidities. The present guidelines aim to provide updated evidence-based recommendations for diagnosis and management of patients with ICAD. Taiwan Stroke Society guideline consensus group developed recommendations for management of patients with ICAD via consensus meetings based on updated evidences. Each proposed class of recommendation and level of evidence was approved by all members of the group. The guidelines cover six topics, including (1) epidemiology and diagnostic evaluation of ICAD, (2) nonpharmacological management of ICAD, (3) medical therapy for symptomatic ICAD, (4) endovascular thrombectomy and rescue therapy for acute ischemic stroke with underlying ICAD, (5) endovascular interventional therapy for postacute symptomatic intracranial arterial stenosis, and (6) surgical treatment of chronic symptomatic intracranial arterial stenosis. Intensive medical treatment including antiplatelet therapy, risk factor control, and life style modification are essential for patients with ICAD.
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Affiliation(s)
- Chun-Jen Lin
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Ping Chung
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Nien-Chen Liao
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Po-Lin Chen
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Nai-Fang Chi
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yen-Jun Lai
- Radiology Department, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chih-Wei Tang
- Neurology Department and Stroke Center, Far-Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Li-Yu Fay
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chun-Fu Lin
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chung-Hsing Chou
- Neurology Department, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC
| | - Jiunn-Tay Lee
- Neurology Department, Tri-Service General Hospital, Taipei, Taiwan, ROC
| | - Jiann-Shing Jeng
- Department of Neurology and Stroke Center, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - I-Hui Lee
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Khachatryan T, Shafie M, Abcede H, Shah J, Nagamine M, Granstein J, Yuki I, Golshani K, Suzuki S, Yu W. Rescue therapy after thrombectomy for large vessel occlusion due to underlying atherosclerosis: review of literature. Front Neurol 2023; 14:1181295. [PMID: 37396754 PMCID: PMC10313123 DOI: 10.3389/fneur.2023.1181295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/24/2023] [Indexed: 07/04/2023] Open
Abstract
In this review article, we summarized the current advances in rescue management for reperfusion therapy of acute ischemic stroke from large vessel occlusion due to underlying intracranial atherosclerotic stenosis (ICAS). It is estimated that 24-47% of patients with acute vertebrobasilar artery occlusion have underlying ICAS and superimposed in situ thrombosis. These patients have been found to have longer procedure times, lower recanalization rates, higher rates of reocclusion and lower rates of favorable outcomes than patients with embolic occlusion. Here, we discuss the most recent literature regarding the use of glycoprotein IIb/IIIa inhibitors, angioplasty alone, or angioplasty with stenting for rescue therapy in the setting of failed recanalization or instant/imminent reocclusion during thrombectomy. We also present a case of rescue therapy post intravenous tPA and thrombectomy with intra-arterial tirofiban and balloon angioplasty followed by oral dual antiplatelet therapy in a patient with dominant vertebral artery occlusion due to ICAS. Based on the available literature data, we conclude that glycoprotein IIb/IIIa is a reasonably safe and effective rescue therapy for patients who have had a failed thrombectomy or have residual severe intracranial stenosis. Balloon angioplasty and/or stenting may be helpful as a rescue treatment for patients who have had a failed thrombectomy or are at risk of reocclusion. The effectiveness of immediate stenting for residual stenosis after successful thrombectomy is still uncertain. Rescue therapy does not appear to increase the risk of sICH. Randomized controlled trials are warranted to prove the efficacy of rescue therapy.
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Affiliation(s)
- Tigran Khachatryan
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Mohammad Shafie
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Hermelinda Abcede
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Jay Shah
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Masaki Nagamine
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Justin Granstein
- Department of Neurological Surgery, University of California, Irvine, Irvine, CA, United States
| | - Ichiro Yuki
- Department of Neurological Surgery, University of California, Irvine, Irvine, CA, United States
| | - Kiarash Golshani
- Department of Neurological Surgery, University of California, Irvine, Irvine, CA, United States
| | - Shuichi Suzuki
- Department of Neurological Surgery, University of California, Irvine, Irvine, CA, United States
| | - Wengui Yu
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
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17
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Sang H, Xie D, Tian Y, Nguyen TN, Saver JL, Nogueira RG, Wu J, Long C, Tian Z, Hu Z, Wang T, Li R, Ke Y, Zhu X, Peng D, Chang M, Li L, Ruan J, Wu D, Zi W, Yang Q, Li F, Qiu Z. Association of Tirofiban With Functional Outcomes After Thrombectomy in Acute Ischemic Stroke Due to Intracranial Atherosclerotic Disease. Neurology 2023; 100:e1996-e2006. [PMID: 36941074 PMCID: PMC10186214 DOI: 10.1212/wnl.0000000000207194] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/01/2023] [Indexed: 03/23/2023] Open
Abstract
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 thrombectomy passes (median [IQR] 1 [1-2] vs 1 [1-2], p = 0.004), which was an independent predictor of functional independence. Mediation analysis showed tirofiban-reduced thrombectomy passes explained 20.0% (95% CI 4.1%-76.0%) of the effect of tirofiban on functional independence. DISCUSSION In this post hoc analysis of the RESCUE BT trial, tirofiban was an effective and well-tolerated adjuvant medication of endovascular thrombectomy for patients with large vessel occlusion due to intracranial atherosclerosis. These findings need to be confirmed in future trials. TRIAL REGISTRATION INFORMATION The RESCUE BT trial was registered on the Chinese Clinical Trial Registry: chictr.org.cn, ChiCTR-INR-17014167. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that tirofiban plus endovascular therapy improves 90-day outcome for patients with large vessel occlusion due to intracranial atherosclerosis.
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Affiliation(s)
- Hongfei Sang
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Dongjing Xie
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Yan Tian
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Thanh N Nguyen
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Jeffrey L Saver
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Raul G Nogueira
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Junxiong Wu
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Chen Long
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Zhenxuan Tian
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Zhizhou Hu
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Tao Wang
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Rongzong Li
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Yingbing Ke
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Xiurong Zhu
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Daizhou Peng
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Mingze Chang
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Lingfei Li
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Jie Ruan
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Deping Wu
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Wenjie Zi
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Qingwu Yang
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Fengli Li
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China
| | - Zhongming Qiu
- From the Department of Neurology (H.S., L.L.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine; Department of Neurology (D.X., Y.T., D.W., W.Z., Q.Y., F.L.), Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Neurology and Radiology (T.N.N.), Boston Medical Center, MA; Department of Neurology (J.L.S.), David Geffen School of Medicine at UCLA; Department of Neurology and Neurosurgery (R.G.N.), University of Pittsburgh School of Medicine, PA; Department of Emergency (J.W., C.L.), Xiangtan Central Hospital; Department of Neurology (Z.T.), Sichuan Mianyang 404 Hospital; Department of Neurology (Z.H.), Longyan First Hospital of Fujian Medical University; Department of Neurology (T.W.), Huainan First People's Hospital; Department of Neurology (R.L.), The 924th Hospital of The People's Liberation Army, Guilin; Department of Neurology (Y.K.), Yangluo Branch of Hubei Zhongshan Hospital, Wuhan; Department of Neurology (X.Z.), Chongzhou People's Hospital; Department of Neurology (D.P.), Qianxinan People's Hospital; Department of Neurology (M.C.), Xi'an Third Hospital; Department of Clinical Pharmacy (J.R.), Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, the First Affiliated Hospital, Zhejiang University School of Medicine; and Department of Neurology (Z.Q.), The 903th Hospital of The People's Liberation Army, Hangzhou, China.
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18
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Caroff J, Aubert L, Lavenu-Bombled C, Figueiredo S, Habchi K, Cortese J, Eugene F, Ognard J, Tahon F, Forestier G, Ifergan H, Zhu F, Hak JF, Reyre A, Laubacher M, Traore A, Desilles JP, Derraz I, Moreno R, Bintner M, Charbonnier G, Le Bras A, Veunac L, Gariel F, Redjem H, Sedat J, Tessier G, Dumas V, Gauberti M, Chivot C, Consoli A, Bricout N, Tuilier T, Guedon A, Pop R, Thouant P, Bellanger G, Zannoni R, Soize S, Richter JS, Heck O, Mihalea C, Burel J, Girot JB, Shotar E, Gazzola S, Boulouis G, Kerleroux B. Antithrombotic therapies for neurointerventional surgery: a 2021 French comprehensive national survey. J Neurointerv Surg 2023; 15:402-407. [PMID: 35347058 DOI: 10.1136/neurintsurg-2021-018601] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/15/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Neurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France. METHODS In April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC). RESULTS All 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications. CONCLUSION This nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field.
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Affiliation(s)
- Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Laurent Aubert
- Department of Anesthesia and Surgical Resuscitation Department, Bicetre Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Saclay, Le Kremlin-Bicetre, France
| | - Cécile Lavenu-Bombled
- Department of Biological Hematology, Assistance Publique-Hôpitaux de Paris, Faculté de médecine Paris Saclay, Hospital Bicetre, Le Kremlin-Bicetre, France
| | - Samy Figueiredo
- Department of Anesthesia and Surgical Resuscitation Department, Bicetre Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Saclay, Le Kremlin-Bicetre, France
| | - Kamelia Habchi
- Department of Anesthesia and Surgical Resuscitation Department, Bicetre Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Saclay, Le Kremlin-Bicetre, France
| | - Jonathan Cortese
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | | | - Julien Ognard
- Department of Neuroradiology, CHU Brest, Brest, France
| | - Florence Tahon
- Department of Neuroradiology, Hôpital Privé Clairval, Marseille, France
| | | | - Heloise Ifergan
- Diagnostic and Interventional Neuroradiology, CHU Tours, Tours, France
| | - François Zhu
- Department of Diagnostic and Interventional Neuroradiology, CHU Nancy, Nancy, France.,Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | | | - Anthony Reyre
- Department of Neuroradiology, Hospital Timone, Marseille, France
| | | | - Abdoulaye Traore
- Department of Neuroradiology, Hôpital Louis Pasteur, Colmar, France
| | | | - Imad Derraz
- Department of Neuroradiology, CHU Montpellier, Montpellier, France
| | - Ricardo Moreno
- Department of Neuroradiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marc Bintner
- Department of Neuroradiology, CHU de la Réunion, Saint-Denis, France
| | | | - Anthony Le Bras
- Department of Radiology, CH Bretagne Atlantique Site Chubert, Vannes, France
| | - Louis Veunac
- Department of Radiology, CH de la Cote Basque, Bayonne, France
| | - Florent Gariel
- Department of Interventional Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, France
| | - Hocine Redjem
- Department of Interventional Neuroradiology, Clinique des Cèdres, Toulouse, France
| | - Jacques Sedat
- Department of Interventional Neuroradiology, CHU Nice, Nice, France
| | | | - Victor Dumas
- Department of Radiology, CHU Poitiers, Poitiers, France
| | | | - Cyril Chivot
- Department of Neuroradiology, CHU Amiens-Picardie, Amiens, Hauts-de-France, France
| | - Arturo Consoli
- Department of Neuroradiology, Hospital Foch, Suresnes, France
| | - Nicolas Bricout
- Department of Interventional Neuroradiology, CHU Lille, Lille, France
| | - Titien Tuilier
- Department of Neuroradiology, CHU Henri Mondor, Créteil, France
| | - Alexis Guedon
- Department of Neuroradiology, CHU Lariboisiere Fernand-Widal, Paris, France
| | - Raoul Pop
- Department of Neuroradiology, CHU Strasbourg, Strasbourg, France
| | | | | | - Riccardo Zannoni
- Department of Neuroradiology, CHU Saint-Etienne, Saint-Etienne, France
| | | | | | - Olivier Heck
- Department of Neuroradiology, CHU Grenoble, Grenoble, France
| | - Cristian Mihalea
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Julien Burel
- Department of Radiology, CHU Rouen, Rouen, France
| | | | - Eimad Shotar
- Department of Neuroradiology, CHU Pitié Salpêtrière, Paris, France
| | - Sebastian Gazzola
- Department of Neuroradiology, Saint Anne Military Hospital, Toulon, France
| | | | - Basile Kerleroux
- Department of Neuroradiologie, Saint Anne Hospital, Paris, France
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19
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Abstract
PURPOSE OF REVIEW This review aims to summarize the therapeutic advances and evidence in the medical management of acute ischemic stroke (AIS). Recent evidence comparing the efficacy and safety of tenecteplase (TNK) with alteplase for intravenous thrombolysis (IVT) in AIS will be highlighted. Recent advances and evidence on improving micro-circulation following endovascular procedures and neuroprotection will be reviewed. RECENT FINDINGS A significant number of randomized control studies now support the use of tenecteplase for IVT in AIS. TNK 0.25 mg/kg single bolus is as effective and well tolerated as alteplase 0.9 mg/kg infusion for IVT in AIS. Evidence from randomized control trials (RCTs) has shown effective and well tolerated expansion of the therapeutic window of IVT in the wake-up stroke and up to 9 h after last seen well, using advanced neuroimaging with computed tomography perfusion/MRI. Early evidence suggests that intra-arterial alteplase may help improve microcirculation in patients with large vessel occlusion following successful thrombectomy. However, more trials are required to confirm the results. Similarly, early evidence from a recent RCT showed that remote ischemic conditioning confers potential neuroprotection and improves outcomes in AIS. SUMMARY Converging evidence has demonstrated that for patients with ischemic stroke presenting at under 4.5 h from the onset, TNK is comparable to alteplase. These data along with the practical advantages of TNK have resulted in a shift to replace intravenous TNK as the standard for thrombolysis. Ongoing studies of IVT with TNK are focussed on defining the optimal dose, expanding the time window with multimodal imaging and defining the role of thrombolysis for bridging patients with stroke due to large vessel occlusion.
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Affiliation(s)
- Radhika Nair
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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20
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Shang X, He C, Yang K, Guo Y, Zhou Z, Zi W. Effects of Antecedent Intravenous Thrombolysis on Endovascular Treatment of Acute Stroke Using Tirofiban. J Vasc Interv Radiol 2023; 34:420-426. [PMID: 36509235 DOI: 10.1016/j.jvir.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate whether preceding intravenous thrombolysis combined with tirofiban in patients with acute ischemic stroke undergoing endovascular treatment is safe and effective. MATERIALS AND METHODS Consecutive data were identified for patients who experienced acute ischemic stroke and were admitted to 2 comprehensive stroke centers from January 2015 to August 2021. All patients were divided into 2 groups-a thrombolytic with tirofiban group and a tirofiban-alone group-on the basis of whether intravenous thrombolysis before emergency endovascular angioplasty was used. Multivariate regression and propensity adjustment analyses were performed to characterize differences in safety and clinical outcomes between the 2 groups. RESULTS Of 373 eligible patients, 111 (29.7%) were treated with thrombolysis with tirofiban. There was a significant difference in the rate of any intracerebral hemorrhage (35.1% vs 24.8%; P = .04) but not in the rates of symptomatic intracerebral hemorrhage (16.2% vs 11.5%; P = .23) and reocclusion at 24 hours (5.4% vs 7.6%; P = .51) between the 2 groups. Multivariate regression analysis revealed that intravenous thrombolysis was not associated with any or symptomatic intracerebral hemorrhage, artery occlusion, functional outcome, or death at the 3-month follow-up (all adjusted P > .05). After propensity adjustment, the thrombolytic with tirofiban group showed nonsignificant rates of clinical and safety outcomes compared with those of the tirofiban-alone group (all P > .05). CONCLUSIONS Tirofiban may be used without increasing the risk of adverse events in selected patients who experienced ischemic stroke and were treated with intravenous thrombolysis and endovascular therapy.
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Affiliation(s)
- Xianjin Shang
- Department of Neurology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Caifeng He
- Department of Dermatology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Ke Yang
- Department of Neurology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Yapeng Guo
- Department of Neurology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Zhiming Zhou
- Department of Neurology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China.
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21
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Successful endovascular thrombectomy 8 days after onset of acute ischemic stroke: A case report. Heliyon 2023; 9:e13259. [PMID: 36816246 PMCID: PMC9932645 DOI: 10.1016/j.heliyon.2023.e13259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 12/19/2022] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
Endovascular thrombectomy (EVT) is the recommended option for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) that within 6 h onset of stroke. The EVT treatment time window has been extended to 24 h in carefully selected patients by DAWN trial. Recent evidences indicated that some patients presented beyond 24 h still potentially benefit from EVT treatment. Herein, we describe one case of successful delayed EVT in a 50-year-old male AIS patient with an 8-day history of left middle cerebral artery occlusion. Before surgery, CT perfusion demonstrated a marked left hypoperfusion with penumbra volume of 127 mL and ischemic core volume of 10 mL. EVT was performed with complete recanalization and significant improvement in his neurological deficits at 90-days post-surgery follow-up. In future, more randomized clinical trials are warranted to further confirm the safety, efficacy, as well as the applicable population of delayed EVT.
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22
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Wang Y, Ma H, Zhang Q, Jin F, Xu Y, Ma Q, Ji X. Factors affecting the outcomes of tirofiban after endovascular treatment in acute ischemic stroke: Experience from a single center. CNS Neurosci Ther 2023; 29:957-967. [PMID: 36601660 PMCID: PMC9928549 DOI: 10.1111/cns.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 01/06/2023] Open
Abstract
AIMS To investigate the predicted factors influencing the outcomes in acute ischemic stroke (AIS) patients who received tirofiban after endovascular treatment (EVT) and the optimal administration of tirofiban. METHODS In this retrospective study, AIS patients who received EVT followed by tirofiban between January 2017 and October 2021 were enrolled. The dose and duration of tirofiban were adjusted by trained clinicians according to the patient's clinical status. A reduction of at least four points on the National Institutes of Health Stroke Scale (NIHSS) after tirofiban compared with that before tirofiban was defined as an effective response. A modified ranking scale (mRS) of 0-2 was defined as a favorable outcome at a 90-day follow-up. RESULTS A total of 260 consecutive patients were enrolled, and 36.5% of patients achieved a favorable outcome. The modified thrombolysis in cerebral infarction (mTICI) 2b-3 occurred in 93.5% of patients. Symptomatic intracerebral hemorrhage (sICH) occurred in 6.2% of patients, and the mortality at 90-day follow-up was 16.9%. Duration of tirofiban >24 h (adjusted OR: 2.545; 95% CI: 1.008-6.423; p = 0.048) and effective response to tirofiban (adjusted OR: 25.562; 95% CI: 9.794-66.715; p < 0.001) were related to the favorable outcome (mRS 0-2). Higher NIHSS (adjusted OR: 0.855; 95% CI: 0.809-0.904; p < 0.001) and glucose level on admission (adjusted OR: 0.843; 95% CI: 0.731-0.971; p = 0.018) were predictive for the unfavorable outcome (mRS 3-6). CONCLUSIONS An effective response to tirofiban is an independent factor in predicting the long-term efficacy outcome, and extending the duration of tirofiban is beneficial for neurological improvement.
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Affiliation(s)
- Yuan Wang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Hongrui Ma
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Qihan Zhang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Feiyang Jin
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Yi Xu
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Qingfeng Ma
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
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23
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Sun J, Lam C, Christie L, Blair C, Li X, Werdiger F, Yang Q, Bivard A, Lin L, Parsons M. Risk factors of hemorrhagic transformation in acute ischaemic stroke: A systematic review and meta-analysis. Front Neurol 2023; 14:1079205. [PMID: 36891475 PMCID: PMC9986457 DOI: 10.3389/fneur.2023.1079205] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
Background Hemorrhagic transformation (HT) following reperfusion therapies for acute ischaemic stroke often predicts a poor prognosis. This systematic review and meta-analysis aims to identify risk factors for HT, and how these vary with hyperacute treatment [intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT)]. Methods Electronic databases PubMed and EMBASE were used to search relevant studies. Pooled odds ratio (OR) with 95% confidence interval (CI) were estimated. Results A total of 120 studies were included. Atrial fibrillation and NIHSS score were common predictors for any intracerebral hemorrhage (ICH) after reperfusion therapies (both IVT and EVT), while a hyperdense artery sign (OR = 2.605, 95% CI 1.212-5.599, I 2 = 0.0%) and number of thrombectomy passes (OR = 1.151, 95% CI 1.041-1.272, I 2 = 54.3%) were predictors of any ICH after IVT and EVT, respectively. Common predictors for symptomatic ICH (sICH) after reperfusion therapies were age and serum glucose level. Atrial fibrillation (OR = 3.867, 95% CI 1.970-7.591, I 2 = 29.1%), NIHSS score (OR = 1.082, 95% CI 1.060-1.105, I 2 = 54.5%) and onset-to-treatment time (OR = 1.003, 95% CI 1.001-1.005, I 2 = 0.0%) were predictors of sICH after IVT. Alberta Stroke Program Early CT score (ASPECTS) (OR = 0.686, 95% CI 0.565-0.833, I 2 =77.6%) and number of thrombectomy passes (OR = 1.374, 95% CI 1.012-1.866, I 2 = 86.4%) were predictors of sICH after EVT. Conclusion Several predictors of ICH were identified, which varied by treatment type. Studies based on larger and multi-center data sets should be prioritized to confirm the results. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=268927, identifier: CRD42021268927.
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Affiliation(s)
- Jiacheng Sun
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Christina Lam
- Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Lauren Christie
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Allied Health Research Unit, St Vincent's Health Network Sydney, Sydney, NSW, Australia.,Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
| | - Christopher Blair
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia
| | - Xingjuan Li
- Queensland Department of Agriculture and Fisheries, Brisbane, QLD, Australia
| | - Freda Werdiger
- Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Qing Yang
- Apollo Medical Imaging Technology Pty Ltd., Melbourne, VIC, Australia
| | - Andrew Bivard
- Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Longting Lin
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Mark Parsons
- Sydney Brain Centre, The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia
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24
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Low-dose intravenous tirofiban infusion after endovascular recanalization for non-acute middle cerebral artery occlusion. Heliyon 2022; 8:e12354. [PMID: 36619459 PMCID: PMC9813718 DOI: 10.1016/j.heliyon.2022.e12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/18/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background and purpose Endovascular recanalization for patients with symptomatic non-acute middle cerebral artery occlusion still remines challenging. Postoperative treatment is still controversial. This study aims to investigate the safety and effectiveness of tirofiban after elective angioplasty in patients with non-acute middle cerebral artery occlusion related ischemic stroke. Methods Our study is a retrospective case series study of 48 stroke patients who received elective endovascular recanalization for middle cerebral artery occlusion. Patients who received EVT without hemorrhage were divided into 2 groups: those who did not receive intravenous tirofiban treatment (control group, n = 25); those who received continuous intravenous infusion of 0.2-0.3 mg/h tirofiban for 48 h after endovascular recanalization (intravenous tirofiban group, n = 23). Early reocclusion of treated arteries, symptomatic hemorrhage, and 90-day functional outcome of the 2 groups were compared. Results The 90-day mRS score and NIHSS score after endovascular recanalization showed no significantly different between the two groups. However, the rate of mRS score reverse (≥1) was significantly higher in the intravenous tirofiban group than the control (73.9% versus 24.0%, P = 0.001), and the rate of NIHSS score reverse (≥3) in the intravenous tirofiban group was also higher (43.5% verse 16.0%, P = 0.037). The rate of early reocclusion, symptomatic hemorrhage (4.3% versw 4%, P = 0.734), showed no difference between the two groups. Conclusions Low-dose intravenous tirofiban infusion (0.2-0.3 mg/h for 48 h) after endovascular treatment seems to be safe and potentially effective for non-acute middle cerebral artery occlusion patients.
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25
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Li S, Ni J, Fan X, Yao M, Feng F, Li D, Qu J, Zhu Y, Zhou L, Peng B. Study protocol of Branch Atheromatous Disease-related stroke (BAD-study): a multicenter prospective cohort study. BMC Neurol 2022; 22:458. [PMID: 36494618 PMCID: PMC9733351 DOI: 10.1186/s12883-022-02976-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 11/08/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND As a meaningful subtype of ischemic stroke in Asians, Branch atheromatous disease (BAD)-related stroke is associated with high early neurological deterioration (END) and disability, but is understudied and without recommended therapy. The mechanism of END still remains unclear. Branch atheromatous disease-related stroke study (BAD-study) therefore aims to investigate demographic, clinical and radiological features, and prognosis of BAD-related stroke in Chinese patients. METHODS/DESIGN BAD-study is a nationwide, multicenter, consecutive, prospective, observational cohort study enrolling patients aged 18-80 years with BAD-related stroke within 72 h after symptom onset. Initial clinical data, laboratory tests, and imaging data are collected via structured case report form, and follow-ups will be performed at 7 days, 30 days, 90 days, 6 months and 12 months after enrollment. The primary outcome is the score on modified Rankin Scale at 90-day follow-up with single-blinded assessment. Secondary outcomes include END within 7 days, and National institute of health stroke scale score, Barthel index, cerebrovascular events, major bleeding complications, and all-cause mortality during 90-day follow-up. Characteristics of penetrating and parent artery will be assessed by high-resolution magnetic resonance imaging combined with other imaging techniques. DISCUSSION BAD-study can provide demographic, clinical, radiological, and prognostic characteristics of BAD-related stroke, and thereby potentially figure out the vascular mechanism of early neurological deterioration and optimize therapy strategy with the aid of advanced imaging technique. Baseline data and evidence will also be generated for randomized controlled trials on BAD-related stroke in the future.
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Affiliation(s)
- Shengde Li
- grid.506261.60000 0001 0706 7839Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China ,grid.413106.10000 0000 9889 6335State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jun Ni
- grid.506261.60000 0001 0706 7839Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China ,grid.413106.10000 0000 9889 6335State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaoyuan Fan
- grid.413106.10000 0000 9889 6335Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Yao
- grid.506261.60000 0001 0706 7839Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China ,grid.413106.10000 0000 9889 6335State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Feng Feng
- grid.413106.10000 0000 9889 6335Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Dongxue Li
- grid.413106.10000 0000 9889 6335Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jianxun Qu
- Research Scientist, Siemens Healthineers, Beijing, China
| | - Yicheng Zhu
- grid.506261.60000 0001 0706 7839Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China ,grid.413106.10000 0000 9889 6335State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lixin Zhou
- grid.506261.60000 0001 0706 7839Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China ,grid.413106.10000 0000 9889 6335State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bin Peng
- grid.506261.60000 0001 0706 7839Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China ,grid.413106.10000 0000 9889 6335State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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26
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Safety and Efficacy of Tirofiban in Severe Ischemic Stroke Patients Undergoing Mechanical Thrombectomy. J Cardiovasc Dev Dis 2022; 9:jcdd9110408. [PMID: 36421943 PMCID: PMC9699197 DOI: 10.3390/jcdd9110408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
Abstract
Tirofiban has recently shown encouraging efficacy and safety among acute ischemic stroke (AIS) patients with mechanical thrombectomy (MT). However, the benefits of tirofiban varied among studies depending on the patient’s condition, which was often not well analyzed. This study aimed to identify the characteristics of patients who may obtain the largest benefits from tirofiban. The efficacy endpoint was a favorable outcome defined as a modified Rankin Scale (mRS) score of 0~2 at 90 days. The safety endpoints were intracranial hemorrhage (ICH), symptomatic intracranial hemorrhage (sICH) and mortality at 90 days. Adjusted logistic regression analysis and subgroup analyses were utilized to investigate the factors associated with tirofiban and the outcome. All of 285 patients fit the inclusion criteria. Tirofiban was associated with a higher rate of favorable outcome (aOR 2.033, 95% CI, 1.002~4.123, p = 0.043) but not with an increased risk of ICH, sICH or mortality (p > 0.05). Moreover, subgroup analyses revealed that tirofiban was associated with favorable outcomes in patients with NIHSS > 14 (aOR 2.778, 95% CI 1.056~7.356, p = 0.038) but not in patients with NIHSS ≤ 14 (aOR 1.719, 95% CI 0.646~4.578, p = 0.278). No significant heterogeneity was found in the effect of tirofiban across the subgroups of age, sex, ASPECTS, time from onset to puncture, use of t-PA or stroke etiology (p for interaction > 0.05). The administration of tirofiban was associated with favorable outcomes in severe ischemic stroke patients, and further studies are needed to confirm this finding.
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27
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Zhang Y, Wang J, Ma Z, Mu G, Liang D, Li Y, Qian X, Zhang L, Shen F, Zhang L, Yu J, Liu Y. Prospective pilot study of tirofiban in progressive stroke after intravenous thrombolysis. Front Neurol 2022; 13:982684. [PMID: 36267890 PMCID: PMC9577296 DOI: 10.3389/fneur.2022.982684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Intravenous thrombolysis (IVT) is a standard procedure for the treatment of patients with acute ischemic stroke (AIS). Improving the therapeutic efficacy of IVT is an important task for neurologists. The aim of this study was to evaluate the efficacy and safety of early low-dose tirofiban treatment in AIS patients with early neurological deterioration (END) after IVT. Methods In this prospective and randomized pilot study, 73 AIS patients with END were recruited from a local hospital in China. Of these, 14 patients were treated with regular antiplatelet agents (aspirin plus clopidogrel) and 59 patients were treated with tirofiban within 24 h of IVT, followed by regular antiplatelet therapy. Neurological deficits and functional recovery were assessed with NIHSS and modified Rankin Scale (mRS) at 7 and 90 days. During the 90-day follow-up period, both hemorrhagic (e.g., intracerebral hemorrhage) and non-hemorrhagic (e.g., pneumonia) events were recorded. Results Treatment with tirofiban compared with regular antiplatelet therapy: (1) improved functional recovery of AIS patients to mRS (≤2) at both 7 and 90 days (odds ratios [ORs], 1.37 and 1.64; 95% confidence interval [CI], 1.16–1.61 and 1.26–2.12; P = 0.008 and < 0.001, respectively), and (2) reduced NIHSS scores from 11.14 ± 2.38 to 5.95 ± 3.48 at day 7 (P < 0.001) and from 8.14 ± 2.74 to 4.08 ± 3.50 at day 90 (P < 0.001). Tirofiban treatment did not increase the risk of hemorrhagic complications. Multivariate regression analysis showed that tirofiban treatment independently predicted a favorable functional outcome (P ≤ 0.001). Conclusion Early treatment with low-dose tirofiban in AIS patients with neurologic deterioration after IVT potentially improved functional recovery and attenuated neurologic deficits as early as 7 days and did not increase the risk of various hemorrhagic complications. However, the therapeutic efficacy of tirofiban treatment in END patients needs to be determined by future randomized clinical trials with a large study population. Clinical trial registration http://www.chictr.org.cn/, Identifier ChiCTR2200058513.
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Affiliation(s)
- Yan Zhang
- Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
- *Correspondence: Yan Zhang
| | - Jianliang Wang
- Department of Radiology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Zhaoxi Ma
- Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Guihua Mu
- Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Da Liang
- Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Yifan Li
- Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Xiaoyan Qian
- Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Luyuan Zhang
- Department of Scientific and Technological Talents, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Fang Shen
- Department of Outpatient, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Lei Zhang
- Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Jie Yu
- Department of Neurology, The Second People's Hospital of Kunshan, Kunshan, China
| | - Yang Liu
- Department of Neurology, Saarland University, Homburg, Germany
- Yang Liu
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28
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Guo W, Xu J, Ma L, Ma J, Li S, Ren C, Wu L, Wu C, Li C, Chen J, Duan J, Ma Q, Song H, Zhao W, Ji X. Safety and efficacy of different tirofiban administration routes on acute ischemic stroke patients with successful recanalization: A propensity score matching analysis. CNS Neurosci Ther 2022; 28:1993-2000. [PMID: 35962605 PMCID: PMC9627363 DOI: 10.1111/cns.13936] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/12/2022] [Accepted: 07/27/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE This study aimed to explore the effect of different administration routes of a low dose of tirofiban on acute ischemic stroke (AIS) patients with successful recanalization after endovascular treatment (EVT). METHODS This is a cohort study that retrospectively analyzed data of patients with AIS who underwent EVT and achieved successful recanalization from a prospective registry. Eligible patients were divided into three groups according to their use of tirofiban. Propensity score matching (PSM) was used to balance baseline bias. Safety outcomes included any intracranial hemorrhage (ICH) and symptomatic ICH (sICH). Efficacy outcomes included arterial reocclusion, in-hospital mortality, 3-month mortality, and 3-month functional outcomes. RESULTS We included 821 patients with 306 in the no tirofiban group, 202 in the IA + IV tirofiban group, and 313 in the IV tirofiban group. After PSM, each group included 101 patients with balanced baseline characteristics. There was no difference between the IV tirofiban group and the no tirofiban group in terms of safety and efficacy outcomes (all p > 0.05). Compared with no tirofiban, IA + IV tirofiban group did not increase ICH (30.7% vs. 37.6%, p > 0.05) and sICH (6.9% vs. 17.8%, p > 0.05) whereas reduced 3-month mortality (14.3% vs. 28.7%, p < 0.05) and improved 3-month modified Rankin Scale (median 3 vs. 4, p < 0.05). CONCLUSIONS A low dose of tirofiban, regardless of their administration routes, was safe for AIS patients who achieved successful recanalization with EVT, whereas only IA + IV tirofiban improved clinical outcomes.
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Affiliation(s)
- Wenting Guo
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Jiali Xu
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Linqing Ma
- Department of NeurologyThe People's Hospital of Suzhou New DistrictSuzhouChina
| | - Jin Ma
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Sijie Li
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Changhong Ren
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Longfei Wu
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Chuanjie Wu
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Chuanhui Li
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Jian Chen
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Jiangang Duan
- Department of Emergency, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Qingfeng Ma
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Haiqing Song
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Wenbo Zhao
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina,Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xunming Ji
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina,Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina,Beijing Institute of Brain DisordersCapital Medical UniversityBeijingChina
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29
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Yi T, Zhan A, Wu Y, Li Y, Zheng X, Lin D, Lin X, Pan Z, Chen R, Parsons M, Chen W, Lin L. Endovascular Treatment of ICAS Patients: Targeting Reperfusion Rather than Residual Stenosis. Brain Sci 2022; 12:brainsci12080966. [PMID: 35892407 PMCID: PMC9332149 DOI: 10.3390/brainsci12080966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 02/05/2023] Open
Abstract
Background and Purpose: Previous studies showed that acute reocclusion after endovascular therapy is related to residual stenosis. However, we observed that reperfusion status but not residual stenosis severity is related to acute reocclusion. This study aimed to assess which factor mention above is more likely to be associated with artery reocclusion after endovascular treatment. Methods: This study included 86 acute ischemic stroke patients who had middle cerebral artery (MCA) atherosclerotic occlusions and received endovascular treatment within 24 h of a stroke. The primary outcomes included intraprocedural reocclusion assessed during endovascular treatment and delayed reocclusion assessed through follow-up angiography. Results: Of the 86 patients, the intraprocedural reocclusion rate was 7.0% (6/86) and the delayed reocclusion rate was 2.3% (2/86). Regarding intraprocedural occlusion, for patients with severe residual stenosis, patients with successful thrombectomy reperfusion showed a significantly lower rate than unsuccessful thrombectomy reperfusion (0/30 vs. 6/31, p = 0.003); on the other hand, for patients with successful thrombectomy reperfusion, patients with severe residual stenosis showed no difference from those with mild to moderate residual stenosis in terms of intraprocedural occlusion (0/30 vs. 0/25, p = 1.00). In addition, after endovascular treatment, all patients achieved successful reperfusion. There was no significant difference in the delayed reocclusion rate between patients with severe residual stenosis and those with mild to moderate residual stenosis (2/25 vs. 0/61, p = 0.085). Conclusion: Reperfusion status rather than residual stenosis severity is associated with artery reocclusion after endovascular treatment. Once successful reperfusion was achieved, the reocclusion occurrence was fairly low in MCA atherosclerosis stroke patients, even with severe residual stenosis.
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Affiliation(s)
- Tingyu Yi
- Cerebrovascular and Neuro-Intervention Department, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China; (T.Y.); (Y.W.); (X.Z.); (D.L.); (X.L.); (Z.P.); (R.C.)
| | - Alai Zhan
- Radiology Department, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China; (A.Z.); (Y.L.)
| | - Yanmin Wu
- Cerebrovascular and Neuro-Intervention Department, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China; (T.Y.); (Y.W.); (X.Z.); (D.L.); (X.L.); (Z.P.); (R.C.)
| | - Yimin Li
- Radiology Department, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China; (A.Z.); (Y.L.)
| | - Xiufen Zheng
- Cerebrovascular and Neuro-Intervention Department, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China; (T.Y.); (Y.W.); (X.Z.); (D.L.); (X.L.); (Z.P.); (R.C.)
| | - Dinglai Lin
- Cerebrovascular and Neuro-Intervention Department, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China; (T.Y.); (Y.W.); (X.Z.); (D.L.); (X.L.); (Z.P.); (R.C.)
| | - Xiaohui Lin
- Cerebrovascular and Neuro-Intervention Department, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China; (T.Y.); (Y.W.); (X.Z.); (D.L.); (X.L.); (Z.P.); (R.C.)
| | - Zhinan Pan
- Cerebrovascular and Neuro-Intervention Department, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China; (T.Y.); (Y.W.); (X.Z.); (D.L.); (X.L.); (Z.P.); (R.C.)
| | - Rongcheng Chen
- Cerebrovascular and Neuro-Intervention Department, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China; (T.Y.); (Y.W.); (X.Z.); (D.L.); (X.L.); (Z.P.); (R.C.)
| | - Mark Parsons
- Department of Neurology and Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3050, Australia;
| | - Wenhuo Chen
- Cerebrovascular and Neuro-Intervention Department, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China; (T.Y.); (Y.W.); (X.Z.); (D.L.); (X.L.); (Z.P.); (R.C.)
- Correspondence: (W.C.); (L.L.); Tel.: +86-13806906089 (W.C.); +86-13777446074 (L.L.)
| | - Longting Lin
- Department of Neurology and Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC 3050, Australia;
- Correspondence: (W.C.); (L.L.); Tel.: +86-13806906089 (W.C.); +86-13777446074 (L.L.)
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30
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Li W, Lin G, Xiao Z, Zhang Y, Li B, Zhou Y, Chai E. Safety and Efficacy of Tirofiban During Intravenous Thrombolysis Bridging to Mechanical Thrombectomy for Acute Ischemic Stroke Patients: A Meta-Analysis. Front Neurol 2022; 13:851910. [PMID: 35572929 PMCID: PMC9099208 DOI: 10.3389/fneur.2022.851910] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The safety and efficacy of tirofiban in intravenous thrombolysis (IVT) bridging to mechanical thrombectomy in patients with acute ischemic stroke (AIS) is unknown. The purpose of this meta-analysis was to evaluate the safety and efficacy of tirofiban in IVT bridging to mechanical thrombectomy in acute ischemic stroke. Methods We systematically searched PubMed, EMBASE, Web of Science, and The Cochrane Library, CNKI, and Wan Fang databases for randomized controlled trials and observational studies (case-control studies and cohort studies) comparing the tirofiban and non-tirofiban groups in AIS intravenous thrombolysis bridging to mechanical thrombectomy (Published by November 20, 2021). Our primary safety endpoints were symptomatic cerebral hemorrhage (sICH), intracranial hemorrhage (ICH), postoperative re-occlusion, and 3-month mortality; the efficacy endpoints were 3-month favorable functional outcome (MRS ≤ 2) and successful recanalization rate (modified thrombolytic therapy in cerebral infarction (mTICI) 2b or 3). Results A total of 7 studies with 1,176 patients were included in this meta-analysis. A comprehensive analysis of the included literature showed that the difference between the tirofiban and non-tirofiban groups in terms of successful recanalization (OR = 1.19, 95% Cl [0.69, 2.03], p = 0.53, I2 = 22%) and favorable functional outcome at 3 months (OR = 1.13, 95% Cl [0.81, 1.60], p = 0.47, I2 = 17%) in patients with IVT bridging mechanical thrombectomy of AIS was not statistically significant. Also, the differences in the incidence of sICH (OR = 0.97, 95% Cl [0.58, 1.62], p = 0.89) and ICH (OR = 0.83, 95% Cl [0.55, 1.24], p = 0.36) between the two groups were not statistically significant. However, the use of tirofiban during IVT bridging mechanical thrombectomy reduced the rate of postoperative re-occlusion (OR = 0.36, 95% Cl [0.14, 0.91], p = 0.03) and mortality within 3 months (OR = 0.54, 95% Cl [0.33, 0.87], p = 0.01) in patients. Conclusion The use of tirofiban during IVT bridging mechanical thrombectomy for AIS does not increase the risk of sICH and ICH in patients and reduces the risk of postoperative re-occlusion and mortality in patients within 3 months. However, this result needs to be further confirmed by additional large-sample, multicenter, prospective randomized controlled trials. Systematic Review Registration http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022297441.
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Affiliation(s)
- Wei Li
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lanzhou, China
| | - Guohui Lin
- Day Treatment Center II of Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Zaixing Xiao
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lanzhou, China
| | - Yichuan Zhang
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lanzhou, China
| | - Bin Li
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lanzhou, China
| | - Yu Zhou
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lanzhou, China
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China
| | - Erqing Chai
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lanzhou, China
- *Correspondence: Erqing Chai
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31
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Zhang A, Wu N, Liu X, Jiang T. Continuous intravenous tirofiban can improve the 90-day functional outcome and decrease 90-day mortality without increasing bleeding risk in acute ischemic stroke patients treated by endovascular therapy: A meta-analysis. J Clin Neurosci 2022; 99:109-116. [PMID: 35278931 DOI: 10.1016/j.jocn.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The role of continuous intravenous administration of tirofiban in endovascular therapy is still unclear. This meta-analysis aims to evaluate the 90-day functional prognosis in acute ischemic stroke patients (AIS) treated by endovascular treatment and intravenous administration of tirofiban. METHODS We searched PubMed, Embase, and CENTRAL databases with the subject terms "tirofiban", "brain ischemia", and some related free words. Inclusion criteria were: (1) cohort study or randomized control trials; (2) AIS patients who received endovascular therapy; (3) the intervention or exposure was intravenous tirofiban monotherapy or combined with intra-arterial tirofiban; (4) containing data on modified Rankin Scale at 90 days and including at least one of the following indicators: mortality, symptomatic intracranial hemorrhage (sICH), intracranial hemorrhage (ICH), and recanalization. A summary odds ratio was calculated. RESULTS Twelve eligible studies, consisting of 3268 AIS participants, were identified. There was a significant trend of favorable outcomes (measured by mRS at three months) in the tirofiban group (ORs = 1.36; 95% CI = 1.09-1.70). In addition, compared with the non-tirofiban group, intravenous tirofiban was significantly associated with decreased risk of 90-day mortality (ORs = 0.73; 95% CI:0.59-0.89) and increased recanalization rate (ORs = 1.50; 95% CI:1.08-2.09) but no significant difference in rates of sICH (ORs = 0.93; 95% CI = 0.70-1.24) or ICH (ORs = 0.84; 95% CI = 0.62-1.15). CONCLUSIONS Intravenous tirofiban appears to be safe and effective when used following intra-arterial tirofiban or as monotherapy in AIS patients treated by endovascular therapy, which can improve the 90-day functional outcome, decrease the 90-day mortality and increase the possibility of early recanalization without increasing rates of sICH and ICH.
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Affiliation(s)
- Aiwu Zhang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Nihong Wu
- Department of Neurology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Xintong Liu
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Tao Jiang
- Department of Neurology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
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32
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Marnat G, Finistis S, Delvoye F, Sibon I, Desilles JP, Mazighi M, Gariel F, Consoli A, Rosso C, Clarençon F, Elhorany M, Denier C, Chalumeau V, Caroff J, Veunac L, Bourdain F, Darcourt J, Olivot JM, Bourcier R, Dargazanli C, Arquizan C, Richard S, Lapergue B, Gory B. Safety and Efficacy of Cangrelor in Acute Stroke Treated with Mechanical Thrombectomy: Endovascular Treatment of Ischemic Stroke Registry and Meta-analysis. AJNR Am J Neuroradiol 2022; 43:410-415. [PMID: 35241418 PMCID: PMC8910798 DOI: 10.3174/ajnr.a7430] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/23/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Rescue therapies are increasingly used in the setting of endovascular therapy for large-vessel occlusion strokes. Among these, cangrelor, a new P2Y12 inhibitor, offers promising pharmacologic properties to join the reperfusion strategies in acute stroke. We assessed the safety and efficacy profiles of cangrelor combined with endovascular therapy in patients with large-vessel-occlusion stroke. MATERIALS AND METHODS We performed a retrospective patient data analysis in the ongoing prospective multicenter observational Endovascular Treatment in Ischemic Stroke Registry in France from July 2018 to December 2020 and conducted a systematic review and meta-analysis using several data bases. Indications for cangrelor administration were rescue strategy in case of refractory intracranial occlusion with or without intracranial rescue stent placement, and cervical carotid artery stent placement in case of cervical occlusion (tandem occlusion or isolated cervical carotid occlusion). RESULTS In the clinical registry, 44 patients were included (median initial NIHSS score, 12; prior intravenous thrombolysis, 29.5%). Intracranial stent placement was performed in 54.5% (n = 24/44), and cervical stent placement, in 27.3% (n = 12/44). Adjunctive aspirin and heparin were administered in 75% (n = 33/44) and 40.9% (n = 18/44), respectively. Rates of symptomatic intracerebral hemorrhage, parenchymal hematoma, and 90-day mortality were 9.5% (n = 4/42), 9.5% (n = 4/42), and 24.4% (n = 10/41). Favorable outcome (90-day mRS, 0-2) was reached in 51.2% (n = 21/41), and successful reperfusion, in 90.9% (n = 40/44). The literature search identified 6 studies involving a total of 171 subjects. In the meta-analysis, including our series data, symptomatic intracerebral hemorrhage occurred in 8.6% of patients (95% CI, 5.0%-14.3%) and favorable outcome was reached in 47.6% of patients (95% CI, 27.4%-68.7%). The 90-day mortality rate was 22.6% (95% CI, 13.6%-35.2%). Day 1 artery patency was observed in 89.7% (95% CI, 81.4%-94.6%). CONCLUSIONS Cangrelor offers promising safety and efficacy profiles, especially considering the complex endovascular reperfusion procedures in which it is usually applied. Further large prospective data are required to confirm these findings.
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Affiliation(s)
- G. Marnat
- From the Department of Diagnostic and Interventional Neuroradiology (G.M., F.G.), University Hospital of Bordeaux, Bordeaux, France
| | - S. Finistis
- Aristotle University of Thessaloniki (S.F.), AhepaHospital, Thessaloniki, Greece
| | - F. Delvoye
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - I. Sibon
- Department of Neurology (I.S.), Stroke Center, University Hospital of Bordeaux, Bordeaux, France
| | - J.-P. Desilles
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - M. Mazighi
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - F. Gariel
- From the Department of Diagnostic and Interventional Neuroradiology (G.M., F.G.), University Hospital of Bordeaux, Bordeaux, France
| | - A. Consoli
- Department of Diagnostic and Interventional Neuroradiology (A.C.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | | | - F. Clarençon
- Neuroradiology (F.C., M.E.), Centre Hospitalier Universitaire Pitié Salpétrière Hospital, Paris, France
| | - M. Elhorany
- Neuroradiology (F.C., M.E.), Centre Hospitalier Universitaire Pitié Salpétrière Hospital, Paris, France
| | | | - V. Chalumeau
- Neuroradiolology (V.C., J.C.) Centre Hospitalier Universitaire Kremlin Bicêtre, Le Kremlin Bicêtre, France
| | - J. Caroff
- Neuroradiolology (V.C., J.C.) Centre Hospitalier Universitaire Kremlin Bicêtre, Le Kremlin Bicêtre, France
| | - L. Veunac
- Neuroradiolology (L.V.), Centre Hospitalier Cõte Basque, Bayonne, France
| | | | - J. Darcourt
- Neuroradiolology (J.D.), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - R. Bourcier
- Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France
| | - C. Dargazanli
- Departments of Interventional Neuroradiology (C. Dargazanli)
| | - C. Arquizan
- Neurology (C.A.), Centre Hospitalier Regional Universitaire Gui de Chauliac, Montpellier, France
| | - S. Richard
- Department of Neurology (S.R.), Université de Lorraine, Centre Hospitalier Regional Universitaire Nancy, Nancy, France
| | - B. Lapergue
- Department of Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - B. Gory
- Department of Diagnostic and Therapeutic Neuroradiology (B.G.), Université de Lorraine, Centre Hospitalier Regional Universitaire Nancy, Nancy, France,Université de Lorraine (B.G.), Imagerie Adaptative Diagnostique et Interventionnelle, Institut National de la Santé et de la Recherche Médicale U1254, Nancy, France
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33
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Ma G, Sun X, Cheng H, Burgin WS, Luo W, Jia W, Liu Y, He W, Geng X, Zhu L, Chen X, Shi H, Xu H, Zhang L, Wang A, Mo D, Ma N, Gao F, Song L, Huo X, Deng Y, Liu L, Luo G, Jia B, Tong X, Liu L, Ren Z, Miao Z. Combined Approach to Eptifibatide and Thrombectomy in Acute Ischemic Stroke Because of Large Vessel Occlusion: A Matched-Control Analysis. Stroke 2022; 53:1580-1588. [PMID: 35105182 DOI: 10.1161/strokeaha.121.036754] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients undergoing mechanical thrombectomy (MT), adjunctive antithrombotic might improve angiographic reperfusion, reduce the risk of distal emboli and reocclusion but possibly expose patients to a higher intracranial hemorrhage risk. This study evaluated the safety and efficacy of combined MT plus eptifibatide for acute ischemic stroke. METHODS This was a propensity-matched analysis of data from 2 prospective trials in Chinese populations: the ANGEL-ACT trial (Endovascular Treatment Key Technique and Emergency Workflow Improvement of Acute Ischemic Stroke) in 111 hospitals between November 2017 and March 2019, and the EPOCH trial (Eptifibatide in Endovascular Treatment of Acute Ischemic Stroke) in 15 hospitals between April 2019 and March 2020. The primary efficacy outcome was good outcome (modified Rankin Scale score 0-2) at 3 months. Secondary efficacy outcomes included the distribution of 3-month modified Rankin Scale scores and poor outcome (modified Rankin Scale score 5-6) and successful recanalization. The safety outcomes included any intracranial hemorrhage, symptomatic intracranial hemorrhage, and 3-month mortality. Mixed-effects logistic regression models were used to account for within-hospital clustering in adjusted analyses. RESULTS Eighty-one combination arm EPOCH subjects were matched with 81 ANGEL-ACT noneptifibatide patients. Compared with the no eptifibatide group, the eptifibatide group had significantly higher rates of successful recanalization (91.3% versus 81.5%; P=0.043) and 3-month good outcomes (53.1% versus 33.3%; P=0.016). No significant difference was found in the remaining outcome measures between the 2 groups. All outcome measures of propensity score matching were consistent with mixed-effects logistic regression models in the total population. CONCLUSIONS This matched-control study demonstrated that MT combined with eptifibatide did not raise major safety concerns and showed a trend of better efficacy outcomes compared with MT alone. Overall, eptifibatide shows potential as a periprocedural adjunctive antithrombotic therapy when combined with MT. Further randomized controlled trials of MT plus eptifibatide should be prioritized. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03844594 (EPOCH), NCT03370939 (ANGEL-ACT).
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Affiliation(s)
- Gaoting Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China (G.M., X.S., D.M., N.M., F.G., L.S., X.H., Y.D., L.L., G.L., B.J., X.Y., Z.M.)
| | - Xuan Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China (G.M., X.S., D.M., N.M., F.G., L.S., X.H., Y.D., L.L., G.L., B.J., X.Y., Z.M.)
| | - Huiran Cheng
- Department of Neurosurgery, Anyang People's Hospital, China (H.C., L.Z.)
| | - W Scott Burgin
- Department of Neurology, Morsani College of Medicine University of South Florida, Tampa (W.S.B.)
| | - Weiliang Luo
- Department of Neurology, Huizhou Municipal Central Hospital, China (W.L.)
| | - Weihua Jia
- Department of Neurology, Beijing Shijingshan Teaching Hospital, Capital Medical University, China (W.J.)
| | - Yajie Liu
- Department of Neurology, Shenzhen Hospital, Southern Medical University, China (Y.L.)
| | - Wenlong He
- Department of Neurology, Xinxiang Central Hospital, China (W.H.)
| | - Xiaokun Geng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, China (X.G.)
| | - Liangfu Zhu
- Department of Neurosurgery, Anyang People's Hospital, China (H.C., L.Z.).,Department of Cerebral Vascular Diseases, Interventional Center, Henan Provincial People's Hospital, Zhengzhou, China (L.Z.)
| | - Xingyu Chen
- Department of Neurology, Zhongshan Hospital Xiamen University, China (X.C.)
| | - Huaizhang Shi
- Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, China (H.S.)
| | - Haowen Xu
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, China (H.X,)
| | | | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University (A.W.)
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China (G.M., X.S., D.M., N.M., F.G., L.S., X.H., Y.D., L.L., G.L., B.J., X.Y., Z.M.)
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China (G.M., X.S., D.M., N.M., F.G., L.S., X.H., Y.D., L.L., G.L., B.J., X.Y., Z.M.)
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China (G.M., X.S., D.M., N.M., F.G., L.S., X.H., Y.D., L.L., G.L., B.J., X.Y., Z.M.)
| | - Ligang Song
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China (G.M., X.S., D.M., N.M., F.G., L.S., X.H., Y.D., L.L., G.L., B.J., X.Y., Z.M.)
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China (G.M., X.S., D.M., N.M., F.G., L.S., X.H., Y.D., L.L., G.L., B.J., X.Y., Z.M.)
| | - Yiming Deng
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China (G.M., X.S., D.M., N.M., F.G., L.S., X.H., Y.D., L.L., G.L., B.J., X.Y., Z.M.)
| | - Lian Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China (G.M., X.S., D.M., N.M., F.G., L.S., X.H., Y.D., L.L., G.L., B.J., X.Y., Z.M.).,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (L.L.)
| | - Gang Luo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China (G.M., X.S., D.M., N.M., F.G., L.S., X.H., Y.D., L.L., G.L., B.J., X.Y., Z.M.)
| | - Baixue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China (G.M., X.S., D.M., N.M., F.G., L.S., X.H., Y.D., L.L., G.L., B.J., X.Y., Z.M.)
| | | | | | - Zeguang Ren
- Department of Neurosurgery, University of South Florida, Tampa (Z.R.)
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China (G.M., X.S., D.M., N.M., F.G., L.S., X.H., Y.D., L.L., G.L., B.J., X.Y., Z.M.)
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Cai L, Yu X, Yu J, Xu J, Xu L, Ling C, Lou M, Yu C, Qian C. Can Tirofiban Improve the Outcome of Patients With Acute Ischemic Stroke: A Propensity Score Matching Analysis. Front Neurol 2021; 12:688019. [PMID: 34589044 PMCID: PMC8475187 DOI: 10.3389/fneur.2021.688019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/28/2021] [Indexed: 02/02/2023] Open
Abstract
Objective: To evaluate the efficacy and safety of tirofiban for patients with acute ischemic stroke (AIS), especially posterior circulation stroke (PCS). Methods: We enrolled consecutive patients with AIS who suffered large artery occlusion (LAO) and underwent mechanical thrombectomy (MT) between January 2016 and May 2020. Patients were divided into two groups according to whether tirofiban was used during MT. The primary efficacy outcome was a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0–2 at 3 months. The safety outcomes were the rate of mortality at 3 months and the presence of intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH). Cohorts were balanced using 1:1 propensity score matching (PSM). Subgroup analysis was further performed to compare the efficacy and safety of tirofiban between the anterior circulation stroke (ACS) and PCS groups. Results: A total of 292 patients were eligible for this study and divided into the tirofiban group (n = 51) and the no-tirofiban group (n = 241). In the propensity-score-matched cohort, the tirofiban group had a higher rate of favorable outcomes than the no-tirofiban group (49.0 vs. 25.5%, p = 0.014), and the mortality at 3 months showed a greater downward trend in the tirofiban group than the no-tirofiban group (15.6 vs. 33.3% p = 0.064). The risk of sICH and ICH was the same between the tirofiban and control groups (17.6 vs. 27.4% p = 0.236, 31.3 vs. 45.1% p = 0.154, respectively). Tirofiban use was predictive of favorable outcomes [adjusted odds ratio (aOR) = 2.87, 95% confidence interval (CI) 1.52–6.44, p = 0.043] after multiple logistic regression analysis. Subgroup analysis revealed that tirofiban use was significantly associated with favorable outcomes in ACS (aOR = 3.66, 95% CI 1.24–5.22, p = 0.019) but not in PCS (aOR = 1.12, 95% CI 0.47–7.52, p = 0.570). Conclusion: We demonstrated that tirofiban may be associated with improving favorable outcome for the AIS patients who underwent MT, without increasing ICH or sICH. Furthermore, our results indicated that for PCS patients tirofiban may not be associated with favorable outcome, and more comprehensive randomized controlled trials are needed to confirm this finding.
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Affiliation(s)
- Lingxin Cai
- Department of Neurological Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaobo Yu
- Department of Neurological Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Yu
- Department of Neurological Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Xu
- Department of Neurological Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Liang Xu
- Department of Neurological Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chenhan Ling
- Department of Neurological Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Cheng Yu
- Department of Neurosurgery, The Second People's Hospital, Quzhou, China
| | - Cong Qian
- Department of Neurological Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Marnat G, Delvoye F, Finitsis S, Lapergue B, Gariel F, Consoli A, Desilles JP, Mazighi M, Dargazanli C, Bourcier R, Darcourt J, Chalumeau V, Elhorany M, Clarençon F, Richard S, Gory B, Sibon I. A Multicenter Preliminary Study of Cangrelor following Thrombectomy Failure for Refractory Proximal Intracranial Occlusions. AJNR Am J Neuroradiol 2021; 42:1452-1457. [PMID: 34117019 DOI: 10.3174/ajnr.a7180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/09/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Rescue endovascular and pharmacologic approaches are increasingly being adopted after recanalization failure of acute large-vessel occlusion strokes with mechanical thrombectomy, with encouraging results. The safety and efficacy of glycoprotein IIb/IIIa inhibitors in ischemic stroke have been investigated, though cangrelor, a recent intravenous P2Y12-receptor inhibitor with a rapid onset/offset of action and a short half-life, may be a valuable option. We compared the safety and efficacy of cangrelor with those of glycoprotein IIb/IIIa inhibitors for refractory occlusions. MATERIALS AND METHODS We performed a retrospective analysis of the ongoing prospective, multicenter, observational Endovascular Treatment in Ischemic Stroke Registry in France between May 2012 and February 2020. Refractory intracranial occlusions of the anterior and posterior circulation were included and defined as recanalization failure of large-vessel occlusion stroke, perioperative target artery reocclusion, or high risk of early reocclusion related to an arterial wall lesion. The primary end point was a favorable outcome, defined as a 90-day mRS of 0-2. Secondary end points were reperfusion, intracranial hemorrhage, and procedural complications. RESULTS Among 69 patients, 15 were treated with cangrelor, and 54, with glycoprotein IIb/IIIa inhibitors. The favorable outcome (adjusted OR = 2.22; 95% CI, 0.42-11.75; P = .348) and mortality (adjusted OR = 0.44; 95% CI, 0.06-3.16; P = .411) rates were similar in both groups. There was no difference in the rates of any intracranial hemorrhage (adjusted OR = 0.40; 95% CI, 0.08-2.09; P = .280), symptomatic intracranial hemorrhage (6.7% versus 0.0%, P = .058), or procedural complications (6.7% versus 20.4%, P = .215). Reperfusion rates were higher in the cangrelor group, though the difference did not reach statistical significance (93.3% versus 75.0% for modified TICI 2b-3; adjusted OR =10.88; 95% CI, 0.96-123.84; P = .054). CONCLUSIONS Cangrelor seems to be as safe as glycoprotein IIb/IIIa inhibitors for managing refractory intracranial occlusion and leads to satisfactory brain reperfusion. Cangrelor is a promising agent in this setting, and additional studies are warranted to confirm our findings.
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Affiliation(s)
- G Marnat
- Neuroradiology Department (G.M., F.G.) and Neurology (I.S.), Bordeaux University Hospital, Bordeaux, France
| | - F Delvoye
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - S Finitsis
- Aristotle University of Thessaloniki (S.F.), Ahepa Hospital, Thessaloniki, Greece
| | - B Lapergue
- Department of Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin-en-Yvelines University, Suresnes, France
| | - F Gariel
- Neuroradiology Department (G.M., F.G.) and Neurology (I.S.), Bordeaux University Hospital, Bordeaux, France
| | - A Consoli
- Department s of Neuroradiology (A.C.) and Neurology (B.L.), Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - J-P Desilles
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - M Mazighi
- Department of Interventional Neuroradiology (F.D., J.-P.D., M.M.), Rothschild Foundation, Paris, France
| | - C Dargazanli
- Department of Neuroradiology (C.D.), Centre Hospitalier Régional Universitaire Gui de Chauliac, Montpellier, France
| | - R Bourcier
- Department of Neuroradiology (R.B.), University Hospital of Nantes, Nantes, France
| | - J Darcourt
- Department of Neuroradiology (J.D.), University Hospital of Toulouse, Toulouse, France
| | - V Chalumeau
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - M Elhorany
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - F Clarençon
- Department of Neuroradiology (M.E., F.C.), Pitié-Salpêtrière Hospital, Paris, France
| | - S Richard
- Department of Neurology (S.R.), Université de Lorraine, Centre Hospitalier Régional Universitaire-Nancy, Stroke Unit, Nancy, France
- Institut national de la santé et de la recherche médicale U1116 (S.R.), Centre Hospitalier Régional Universitaire-Nancy, Nancy, France
| | - B Gory
- Department of Diagnostic and Therapeutic Neuroradiology (B.G.), Université de Lorraine, CHRU-Nancy, Nancy, France
- Institut National de la Santé et de la Recherche Mmédicale U1254 (B.G.), Université de Lorraine, Imagerie Adaptative Diagnostique et Interventionnelle, Nancy, France
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Jang SH, Sohn SI, Park H, Lee SJ, Kim YW, Hong JM, Kim CH, Choi JW, Kang DH, Kim YS, Hwang YH, Lee JS, Hong JH. The Safety of Intra-arterial Tirofiban during Endovascular Therapy after Intravenous Thrombolysis. AJNR Am J Neuroradiol 2021; 42:1633-1637. [PMID: 34301637 DOI: 10.3174/ajnr.a7203] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/07/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The safety and efficacy of tirofiban during endovascular therapy in patients undergoing intravenous thrombolysis with recombinant IV tPA remain unclear. This study aimed to investigate the safety and efficacy of intra-arterial tirofiban use during endovascular therapy in patients treated with IV tPA. MATERIALS AND METHODS Using a multicenter registry, we enrolled patients with acute ischemic stroke who underwent endovascular therapy. Safety outcomes included postprocedural parenchymal hematoma type 2 and/or thick subarachnoid hemorrhage, intraventricular hemorrhage, and 3-month mortality. Efficacy outcomes included the successful reperfusion rate, postprocedural reocclusion, and good outcomes at 3 months (mRS scores of 0-2). The tirofiban effect on the outcomes was evaluated using a multivariable analysis while adjusting for potential confounders. RESULTS Among enrolled patients, we identified 314 patients with stroke (279 and 35 patients in the no tirofiban and tirofiban groups, respectively) due to an intracranial artery occlusion who underwent endovascular therapy with intravenous thrombolysis. A multivariable analysis revealed no association of intra-arterial tirofiban with postprocedural parenchymal hematoma type and/or thick subarachnoid hemorrhage (adjusted OR, 1.07; 95% CI, 0.20-4.10; P = .918), intraventricular hemorrhage (adjusted OR, 0.43; 95% CI, 0.02-2.85; P = .467), and 3-month mortality (adjusted OR, 0.38; 95% CI, 0.04-1.87; P = .299). Intra-arterial tirofiban was not associated with good outcome (adjusted OR, 2.22; 95% CI, 0.89 -6.12; P = .099). CONCLUSIONS Using intra-arterial tirofiban during endovascular therapy after IV tPA could be safe.
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Affiliation(s)
- S H Jang
- From the Departments of Neurology (S.H.J., S.-I.S., H.P., J.-H.H.)
| | - S-I Sohn
- From the Departments of Neurology (S.H.J., S.-I.S., H.P., J.-H.H.)
| | - H Park
- From the Departments of Neurology (S.H.J., S.-I.S., H.P., J.-H.H.)
| | - S-J Lee
- Department of Neurology (S.-J.L., J.M.H., J.S.L.)
| | - Y-W Kim
- Department of Neurology (Y.-W.K., Y.-H.H.)
| | - J M Hong
- Department of Neurology (S.-J.L., J.M.H., J.S.L.)
| | - C-H Kim
- Neurosurgery (C.-H.K.), School of Medicine Keimyung University, Daegu, South Korea
| | - J W Choi
- Radiology (J.W.C.), School of Medicine, Ajou University, Suwon, South Korea
| | | | - Y-S Kim
- Radiology (Y.-S.K.), School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Y-H Hwang
- Department of Neurology (Y.-W.K., Y.-H.H.)
| | - J S Lee
- Department of Neurology (S.-J.L., J.M.H., J.S.L.)
| | - J-H Hong
- From the Departments of Neurology (S.H.J., S.-I.S., H.P., J.-H.H.)
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Ma G, Sun X, Tong X, Jia B, Huo X, Luo G, Wang B, Deng Y, Gao F, Song L, Ma N, Miao Z, Mo D. Safety and Efficacy of Direct Angioplasty in Acute Basilar Artery Occlusion Due to Atherosclerosis. Front Neurol 2021; 12:651653. [PMID: 34349717 PMCID: PMC8326335 DOI: 10.3389/fneur.2021.651653] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Purpose: Endovascular treatment (EVT) is one of the promising treatment options in patients with intracranial atherosclerotic disease (ICAD)-related basilar artery occlusion (BAO). In this study, we compared the safety and efficacy of direct angioplasty (DA) with stent-retriever thrombectomy (SRT) with or without rescue treatment in ICAD-related BAO. Methods: We retrospectively evaluated 187 patients who underwent EVT for BAO from January 2012 to July 2018. We identified patients who underwent EVT due to ICAD-related BAO. Patients who accepted SRT with or without rescue treatment were classified into the SRT group. Patients treated with DA with or without stent placement were classified into DA group. Clinical and laboratory findings and outcomes were compared between groups. Results: A total of 108 patients were enrolled, among them 77 underwent SRT and 31 underwent DA; 61 (79.2%) SRT group patients underwent angioplasty with or without stent placement. Compared with patients in the SRT group, those in the DA group experienced a significantly shorter procedure time [60 min (60–120 min) vs. 120 min (60–120 min); p = 0.038] and a lower number of device passes [2 passes (1–2 passes) vs. 3 passes (2–4 passes); p < 0.001]. No significant differences in balloon angioplasty (35.5 vs. 22.1%; p = 0.150), emergent stent placement (64.5 vs. 57.1%; p = 0.481), successful recanalization (93.5 vs. 85.7%; p = 0.340), embolization in distal or new territory (3.2 vs. 9.1%, p = 0.314), and reocclusion (22.6 vs. 9.1%; p = 0.109) among DA and SRT groups were found. Additionally, no differences in symptomatic intracranial hemorrhage incidence [adjusted odds ratio (OR), 0.74; 95% CI, 0.06–9.44; p = 0.815], functional independence (adjusted OR, 1.44; 95% CI, 0.50–4.16; p = 0.497), and mortality rate (adjusted OR, 0.36; 95% CI, 0.06–2.04; p = 0.247) were noted among groups. Conclusions: In certain patients with ICAD-related BAO, DA may shorten procedure time and reduce required device passes compared to SRT. In this study, DA was retrospectively found to be of similar safety and efficacy as SRT.
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Affiliation(s)
- Gaoting Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuan Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baixue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gang Luo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bo Wang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yiming Deng
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ligang Song
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Guo Y, Zhao K, Guo X, Yang M. Antiplatelet therapy and outcomes following endovascular therapy for acute ischemic stroke: A systemic review and meta-analysis. J Clin Neurosci 2021; 90:332-344. [PMID: 34275572 DOI: 10.1016/j.jocn.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/31/2021] [Accepted: 06/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The outcomes of antiplatelet therapy (APT) in patients with acute ischemic stroke (AIS) receiving endovascular therapy (EVT) remains controversial. Thus, we sought to make a systematic review and meta-analysis of recent clinical trials to confirm the safety and efficacy of APT. METHODS All of clinical trails were systematically retrieved from PubMed, Embase and Cochrane. The endpoints or main outcome measures included symptomatic intracranial hemorrhage (sICH), 3-month mortality, successful recanalisation (SR) and 3-month functional independence (FI). Odd ratios (ORs) with their 95% confidence intervals (CIs) were calculated to synthesize effect size by using random-effects models. Sensitivity analysis was performed via calculation of rest data owiting one by one. RESULTS 23 articles were included after screening. APT as an adjunct to EVT was associated with a higher likelihood of pooled successful recanalisation (OR 1.46, 95% CI 1.07-2.00) and 3-month FI (OR 1.24, 95% CI 1.01-1.51), no associated with sICH and 3-month mortality. However, Sensitivity analysis indicated that the association between APT and SR and 3-month FI were unstable. For patients with prior use of APT or receiving intravenous thrombolysis before EVT, no associated were found between APT and all of endpoints above. CONCLUSION Although adjuvant APT appears to increase the number of SR and 3-month FI, the results were unstable. Randomised controlled trials are needed to confirm the efficacy.
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Affiliation(s)
- Yu Guo
- Graduate School, Qinghai University, Xining, Qinghai 810016, China
| | - Kai Zhao
- Graduate School, Qinghai University, Xining, Qinghai 810016, China
| | - Xinmei Guo
- Biomedical Engineering Research Center, Kunming Medical University, Kunming, Yunnan 650504, China
| | - Mingfei Yang
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, Qinghai 810007, China.
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Baek BH, Yoon W, Lee YY, Kim SK, Kim JT, Park MS. Intravenous Tirofiban Infusion After Angioplasty and Stenting in Intracranial Atherosclerotic Stenosis-Related Stroke. Stroke 2021; 52:1601-1608. [PMID: 33793319 DOI: 10.1161/strokeaha.120.033551] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Byung Hyun Baek
- Department of Radiology (B.H.B., W.Y., Y.Y.L., S.K.K.), Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Woong Yoon
- Department of Radiology (B.H.B., W.Y., Y.Y.L., S.K.K.), Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yun Young Lee
- Department of Radiology (B.H.B., W.Y., Y.Y.L., S.K.K.), Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seul Kee Kim
- Department of Radiology (B.H.B., W.Y., Y.Y.L., S.K.K.), Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology (J.-T.K., M.S.P.), Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Man Seok Park
- Department of Neurology (J.-T.K., M.S.P.), Chonnam National University Medical School, Gwangju, Republic of Korea
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40
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Affiliation(s)
- Joseph P Broderick
- Department of Neurology, University of Cincinnati Gairdner Neuroscience Institute, University of Cincinnati Academic Health Center, OH (J.P.H.)
| | - Michael D Hill
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary and Foothills Medical Centre, Alberta, Canada (M.D.H.)
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