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Mohamad J. [Drug therapy for acute and elective stent angioplasty]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00117-024-01310-3. [PMID: 38684541 DOI: 10.1007/s00117-024-01310-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/02/2024]
Abstract
CLINICAL ISSUE Carotid artery stenoses are constrictions of the common carotid artery and the internal carotid artery. They cause around 15% of all cerebral ischemia, which is why their detection and correct treatment play an important role in clinical practice. PRACTICAL RECOMMENDATIONS Depending on the severity and clinical symptoms, carotid artery stenosis is treated conservatively, surgically or endovascularly by means of stent angioplasty. In the case of stent angioplasty in particular, correct drug therapy plays an important role in avoiding/reducing thromboembolic complications.
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Affiliation(s)
- J Mohamad
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße 1, 66424, Homburg/Saar, Deutschland.
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Garayzade R, Berlis A, Schiele S, Ertl M, Schneider H, Müller G, Maurer CJ. Efficacy and Safety Outcomes for Acute Ischemic Stroke Patients Treated with Intravenous Infusion of Tirofiban After Emergent Carotid Artery Stenting. Clin Neuroradiol 2024; 34:163-172. [PMID: 37796321 PMCID: PMC10881598 DOI: 10.1007/s00062-023-01350-7] [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: 04/05/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Emergent stenting of the extracranial internal carotid artery (ICA) in stroke patients requires antiplatelet therapy to prevent in-stent thrombosis with a higher risk of intracranial haemorrhage. AIM OF THE STUDY Assess the efficacy and safety of emergent carotid stenting with intravenous tirofiban in acute ischemic stroke patients. METHODS Primary endpoint: symptomatic hemorrhage. Secondary endpoints: 90-day functional outcome and mortality. RESULTS Of the 62 patients, 21 (34%) received tirofiban as a single antiplatelet, and 41 (66%) received combined therapy. Premedication with anticoagulants and antiplatelets was significantly more frequent in the tirofiban-only group. The rate of symptomatic haemorrhage was significantly lower in the tirofiban-only group than in the combined group (4.8% vs. 27%, p = 0.046). The patients with tirofiban alone had a significantly better functional outcome at day 90 than the combined group (52% vs. 24%, p = 0.028). Mortality was equal (24%) in both groups. Pre-interventional NIHSS score (p = 0.003), significant blood pressure fluctuations (p = 0.012), tandem occlusion (p = 0.023), and thrombolysis (p = 0.044) showed relevant influence on the rate of symptomatic hemorrhage in the entire patient cohort. CONCLUSIONS A single antiplatelet therapy with tirofiban regardless of the premedication may improve the functional outcome in patients with stroke due to acute extracranial carotid lesion and emergent carotid stenting with lower rates of serious intracranial haemorrhage. For patients with high pre-interventional NIHSS score, tandem occlusion and after pre-interventional thrombolysis, caution is advised. Additionally, strict blood pressure monitoring should be conducted during the first 72 h after intervention.
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Affiliation(s)
- Rana Garayzade
- Department of diagnostic and interventional Radiology and Neuroradiology, Augsburg University Hospital, Augsburg, Germany.
| | - Ansgar Berlis
- Department of diagnostic and interventional Radiology and Neuroradiology, Augsburg University Hospital, Augsburg, Germany
| | - Stefan Schiele
- Institute of Mathematics, Augsburg University, Augsburg, Germany
| | - Michael Ertl
- Department of Neurology, Augsburg University Hospital, Augsburg, Germany
| | - Hauke Schneider
- Department of Neurology, Augsburg University Hospital, Augsburg, Germany
| | - Gernot Müller
- Institute of Mathematics, Augsburg University, Augsburg, Germany
| | - Christoph J Maurer
- Department of diagnostic and interventional Radiology and Neuroradiology, Augsburg University Hospital, Augsburg, Germany
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Lu WZ, Lin HA, Hou SK, Bai CH, Lin SF. Efficacy and safety of tirofiban in patients with acute ischemic stroke treated with endovascular thrombectomy: A frequentist and Bayesian meta-analysis. Vascul Pharmacol 2023; 153:107244. [PMID: 37992511 DOI: 10.1016/j.vph.2023.107244] [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: 03/30/2022] [Revised: 08/10/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Tirofiban is an antiplatelet treatment approved for acute coronary syndrome, but it has not been rigorously evaluated for efficacy and safety in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT). METHODS Electronic databases were systematically searched for studies conducted from January 1, 2015, to July 31, 2021, that evaluated tirofiban administration for patients with AIS treated with EVT in comparison with control. Risk ratios (RRs) and confidence intervals (CIs) were estimated for favorable functional outcomes (FFOs), mortality, and symptomatic intracranial hemorrhage (SICH), each 90 days after AIS. Bayesian hierarchical modeling was performed to obtain posterior RR and its 95% highest posterior density (HPD) for validation. RESULTS Compared with controls, tirofiban users exhibited increased FFOs (RR, 1.18; 95% CI, 1.08-1.30), decreased mortality (RR, 0.77; 95% CI, 0.64-0.92), and no difference in SICH (RR, 0.97; 95% CI, 0.77-1.23). Tirofiban users in the postbolus infusion subgroup exhibited increased FFOs (RR, 1.20; 95% CI, 1.07-1.35), decreased mortality (RR, 0.71; 95% CI, 0.58-0.88), and no increase in SICH (RR, 0.97; 95% CI, 0.72-1.29). The bolus-only subgroup showed no differences in FFO, mortality, or SICH between the tirofiban and control groups. Consistent results were obtained for posterior density of FFO (posterior RR, 1.20; 95% HPD, 1.06-1.34), mortality (posterior RR, 0.77; 95% HPD, 0.63-0.92), and SICH (posterior RR, 0.98; 95% HPD, 0.71-1.26). CONCLUSION For patients with AIS treated with EVT, tirofiban improved FFOs, decreased mortality, and did not increase SICH compared with controls; postbolus infusion for administering tirofiban was more favored than the bolus-only regimen.
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Affiliation(s)
- Wei-Zhen Lu
- Department of Emergency Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Hui-An Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sen-Kuang Hou
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Feng Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Piao B, Li T, Zhong H, Yang H, Wang Y, Liu H. Acute profound thrombocytopenia induced by tirofiban in stent assisted embolization of intracranial ruptured aneurysm-a rare case report. Heliyon 2023; 9:e14504. [PMID: 37025769 PMCID: PMC10070362 DOI: 10.1016/j.heliyon.2023.e14504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 03/29/2023] Open
Abstract
Objectives Glycoprotein (GP) IIb/IIIa receptor antagonists (Tirofiban) are often used as antiplatelet agents in patients undergoing interventional therapy due to acute coronary syndrome and cerebrovascular diseases. Thrombocytopenia is a common complication of GP IIb/IIIa receptor antagonist, with an incidence of 1%-5%, whereas acute profound thrombocytopenia (platelet count<20 × 109/L) is extremely rare. We reported a case of acute profound thrombocytopenia due to tirofiban treatment to inhibit platelet aggregation during and after surgery in a patient who underwent stent-assisted embolization for ruptured intracranial aneurysm. Case presentation A 59-year-old female patient, who visited the Emergency Department of our hospital due to sudden headache, vomiting, and unconsciousness for 2 hours. Neurological examination: the patient was unconscious, the pupils on both sides had the same roundness, and the reflection on light was slow. The Hunt-Hess grade was IV. Head CT showed subarachnoid hemorrhage and Fisher's score was 3. We immediately implemented LVIS stent-assisted embolization, intraoperative heparinization, and intraoperative jailing technology to perform dense embolism on aneurysms. The patient was treated with mild hypothermia and Tirofiban 5mL/h intravenous pump. Since then, the patient had developed acute profound thrombocytopenia. Conclusion We reported a case of acute profound thrombocytopenia due to tirofiban treatment during and after interventional therapy. For patients after unilateral nephrectomy, we should pay more attention to avoid the occurrence of thrombocytopenia caused by abnormal metabolism of tirofiban, although the Laboratory examination showed normal results.
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Liu C, Wang S, Xue Y, Wang J, Li H. Safety and Efficacy of Tirofiban Bridging Therapy During a Hybrid Carotid Artery Stenting and Off-Pump Coronary Artery Bypass Grafting Surgery: A Single-Center Study. Clin Ther 2023; 45:292-298. [PMID: 36801114 DOI: 10.1016/j.clinthera.2023.01.012] [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: 05/29/2022] [Revised: 12/14/2022] [Accepted: 01/22/2023] [Indexed: 02/19/2023]
Abstract
PURPOSE The optimal perioperative antithrombosis management for carotid artery stenting (CAS) and coronary artery bypass grafting (CABG) hybrid surgeries remains unclear; however, a more aggressive antithrombotic therapy might be required after a hybrid CAS + CABG duo stent-related intimal injury or the use of protamine-neutralizing heparin. This study evaluated the safety and efficacy of tirofiban as a bridging therapy after a hybrid CAS + CABG surgery. METHODS Between June 2018 and February 2022, a total of 45 patients undergoing a hybrid CAS + off-pump CABG surgery were divided into either the control group (standard dual antiplatelet therapy postsurgery, n = 27) or the tirofiban group (tirofiban bridging + dual antiplatelet therapy, n = 18). The 30-day outcome was compared between the 2 groups, and the primary end points included stroke, postoperative myocardial infarction, and death. FINDINGS Two patients (7.41%) from the control group experienced a stroke. There was a trend toward a lower rate of composite end points, including stroke, postoperative myocardial infarction, and death, within the tirofiban group that did not reach statistical significance (0% vs 11.1%; P = 0.264). The need for a transfusion was similar between the 2 groups (33.33% vs 29.63%; P = 0.793). There were no major bleeding events in the 2 groups. IMPLICATIONS Tirofiban bridging therapy was safe, with a trend toward reducing the risk of ischemic events after a hybrid CAS + off-pump CABG surgery. Tirofiban might be a feasible periprocedural bridging protocol in high-risk patients.
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Affiliation(s)
- Changcheng Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shipan Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuan Xue
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiantao Wang
- Department of Neurosurgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haiyang Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Salahuddin H, Dawod G, Zaidi SF, Shawver J, Burgess R, Jumaa MA. Safety of Low Dose Intravenous Cangrelor in Acute Ischemic Stroke: A Case Series. Front Neurol 2021; 12:636682. [PMID: 34149590 PMCID: PMC8211882 DOI: 10.3389/fneur.2021.636682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Neurointerventional procedures in acute ischemic stroke often require immediate antiplatelet therapy in the cases of acute stenting and occasionally re-occluding vessels. Intravenous cangrelor is a P2Y12 receptor antagonist with short onset and quick offset. The study objective was to evaluate the safety and efficacy of intravenous cangrelor in patients with acute ischemic stroke requiring urgent antiplatelet effect. Methods: Patients who received intravenous cangrelor intra-procedurally during acute ischemic stroke treatment were identified from a prospectively collected database. Cangrelor was administered as a bolus of 15 mcg/kg, followed by an infusion rate of 2 mcg/kg/min. A historical control group consisting of anterior circulation tandem occlusions was used to compare to patients with similar lesions who received intravenous cangrelor. Outcomes of interest included in-stent thrombosis, thromboembolic complications, intracranial hemorrhage, and functional outcomes at 90 days. Results: Twelve patients received intravenous cangrelor for acute ischemic stroke between October 2018 and April 2020 at a comprehensive stroke center. Eleven patients had intra or extracranial stenting performed, which included two posterior circulation lesions. No cases of symptomatic intracranial hemorrhage were reported. At 90 day follow-up, two patients had died and 10 had a good functional outcome. Patients with anterior circulation tandem occlusions who received cangrelor and those who received dual antiplatelets orally had similar radiographic and clinical outcomes. Conclusion: Low dose intravenous cangrelor is similar in safety and efficacy to oral antiplatelets in acute ischemic stroke in a small case series. Larger prospective studies on the efficacy, safety, and effect on procedure times of intravenous cangrelor in neurointervention are warranted.
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Affiliation(s)
- Hisham Salahuddin
- ProMedica Neurosciences Center, Toledo, OH, United States.,Department of Neurology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States.,Department of Neurology, Antelope Valley Hospital, Lancaster, CA, United States
| | - Giana Dawod
- Department of Neurology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
| | - Syed F Zaidi
- ProMedica Neurosciences Center, Toledo, OH, United States.,Department of Neurology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
| | - Julie Shawver
- Department of Neurology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
| | | | - Mouhammad A Jumaa
- ProMedica Neurosciences Center, Toledo, OH, United States.,Department of Neurology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
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Limaye K, Quispe-Orozco D, Zevallos CB, Farooqui M, Dandapat S, Mendez-Ruiz A, Ansari S, Abdelkarim S, Dajles A, Derdeyn C, Samaniego EA, Ortega-Gutierrez S. Safety and Feasibility of Symptomatic Carotid Artery Stent-Assisted Revascularization within 48 Hours after Symptoms Onset. J Stroke Cerebrovasc Dis 2021; 30:105743. [PMID: 33765635 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105743] [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: 01/08/2021] [Revised: 02/11/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the safety and feasibility of carotid artery stenting (CAS) performed in the hyperacute period. METHODS We analyzed a retrospective database of CAS patients from our center. We included patients with symptomatic isolated ipsilateral extracranial carotid stenosis and acute tandem occlusions who underwent CAS. Hyperacute CAS (HCAS) and acute CAS (ACAS) groups were defined as CAS within 48 hours and >48 hours to 14 days from symptoms onset, respectively. The primary outcome was a composite of any stroke, myocardial infarction, or death at 3 months of follow-up. Secondary outcomes were periprocedural complications and restenosis or occlusion rates. RESULTS We included 97 patients, 39 with HCAS and 58 with ACAS. There was no significant difference between groups for the primary outcome (HCAS 3.3% vs. ACAS 6.1%; p = 1). There were no differences in the rate of perioperative complications between groups although a trend was observed (HCAS 15.3% vs. ACAS 3.4%; p = .057). The rate of restenosis or occlusion between groups (HCAS 8.1% vs. ACAS 9,1%; log-rank test p = .8) was similar with a median time of follow-up of 13.7 months. CONCLUSION Based on this study, CAS may be feasible in the hyperacute period. However, there are potential higher rates of perioperative complications in the hyperacute group, primarily occurring in MT patients with acute tandem occlusion. A larger multicenter study may be needed to further corroborate our findings.
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Affiliation(s)
- Kaustubh Limaye
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Darko Quispe-Orozco
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Cynthia B Zevallos
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sudeepta Dandapat
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Alan Mendez-Ruiz
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sameer Ansari
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Samir Abdelkarim
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Andres Dajles
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Colin Derdeyn
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Edgar A Samaniego
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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Zhao H, Feng Y, Rong X, Mao Y, Wang Z, Ling Y, Dong Q, Cao W. Sequential tirofiban infusions combined with endovascular treatment may improve outcomes in acute ischemic stroke - a meta-analysis. Aging (Albany NY) 2021; 13:5426-5441. [PMID: 33582658 PMCID: PMC7950282 DOI: 10.18632/aging.202473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/30/2020] [Indexed: 12/20/2022]
Abstract
In this meta-analysis, we explored whether tirofiban could safely improve outcomes when combined with endovascular therapy in acute ischemic stroke with large vessel occlusion. We searched the PubMed, EMBASE, Web of Science, and The Cochrane Library databases from January 2000 to October 2019 for relevant RCTs/non-RCTs. A total of 13 trials involving 2584 patients, of whom 893 (34.5%) received tirofiban, were ultimately included in the meta-analysis. The results suggested that tirofiban improved patient independence at 90 days (51.2% vs 42.4%; OR 1.26; p =0.02) without increasing the risk of symptomatic intracranial hemorrhage (OR 1.01; p =0.96) or mortality (OR 0.86; p =0.09). There was no association between the use of tirofiban and recanalization rate (OR 1.35; p =0.11). Subgroup analysis showed that a loading dose followed by maintenance doses, but not a single dose, of tirofiban increased favorable 90-day functional outcomes (OR 1.49; p =0.0008). Moreover, low maintenance doses may be more effective than high maintenance doses (OR 1.41; p =0.02). These results suggest that adjunctive tirofiban treatment administered as a loading dose followed by low-dose maintenance may improve functional outcomes of endovascular therapy in acute ischemic stroke.
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Affiliation(s)
- Hongchen Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiwei Feng
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yiting Mao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zigao Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yifeng Ling
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Wenjie Cao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
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Delvoye F, Maier B, Escalard S, Labreuche J, Thion LA, Aknouche S, Hebert S, Redjem H, Smajda S, Ciccio G, Allard J, Sabben C, Obadia M, Maertens de Noordhout A, Olivot JM, Blanc R, Piotin M, Desilles JP, Mazighi M. Antiplatelet Therapy During Emergent Extracranial Internal Carotid Artery Stenting: Comparison of Three Intravenous Antiplatelet Perioperative Strategies. J Stroke Cerebrovasc Dis 2020; 30:105521. [PMID: 33310073 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/25/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Guidelines for antiplatelet therapy administration, during emergent stenting for extra-cranial internal carotid artery (EC-ICA) occlusion in the setting of acute ischemic stroke (AIS) are lacking. Different antiplatelet regimen are used in association to endovascular therapy (EVT) for the treatment of EC-ICA lesions. We aimed to compare the clinical and radiological effects of three intravenous antiplatelet agents used during emergent EC-ICA stenting. MATERIAL AND METHODS Clinical data were collected from January 2015 to December 2019 in a monocentric prospective registry of AIS patients treated by EVT. All patients who underwent emergent EC-ICA stenting were sorted regarding the intravenous antiplatelet agent used during the procedure. RESULTS Among 218 patients treated by EVT for an EC-ICA occlusion of the anterior circulation during the study period, 70 underwent an emergent stenting of the EC-ICA. 60 were included in the present study, 9 received intravenous (IV) Cangrelor, 8 IV abciximab and 43 Aspirin. The rate of favorable neurological outcome, defined as modified Rankin Scale (mRS) ≤ 2 at three months were better in the Cangrelor and Aspirin groups (66,7% and 58,1%, respectively) than in the Abciximab group (37,5%), as well as, the rate of any intracranial ICH (22,2% and 37,2% vs 62,5%). The rate of acute stent reocclusion was similar between groups. CONCLUSION When used as a rescue treatment during emergent stenting of EC-ICA, Cangrelor and Aspirin present a better safety profile than Abciximab, with less intracranial hemorrhages and a higher rate of good clinical outcome. Additional studies are needed to confirm these findings.
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Affiliation(s)
- François Delvoye
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Université de Liège, Belgique.
| | - Benjamin Maier
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France.
| | - Simon Escalard
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Julien Labreuche
- University of Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, F-59000 Lille, France.
| | - Laurie-Anne Thion
- Anesthesiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Soufiane Aknouche
- Clinical Research Unit, Rothschild Foundation Hospital, Paris, France.
| | - Solène Hebert
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Hocine Redjem
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Stanislas Smajda
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Gabriele Ciccio
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Julien Allard
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France.
| | - Candice Sabben
- Neurology Department, Rothschild Foundation Hospital, Paris, France.
| | - Michael Obadia
- Neurology Department, Rothschild Foundation Hospital, Paris, France.
| | | | | | - Raphael Blanc
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France.
| | - Michel Piotin
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France.
| | - Jean-Philippe Desilles
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France; Université de Paris, France.
| | - Mikael Mazighi
- Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 INSERM, Université de Paris, 46 rue Henri Huchard 75018 Paris, France; Université de Paris, France; FHU Neurovasc, France.
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10
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Quispe-Orozco D, Limaye K, Zevallos CB, Farooqui M, Mendez-Ruiz A, Ansari S, Dajles A, Samaniego EA, Derdeyn C, Ortega-Gutierrez S. Safety and efficacy of symptomatic carotid artery stenting performed in an emergency setting. Interv Neuroradiol 2020; 27:411-418. [PMID: 33283595 DOI: 10.1177/1591019920977552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Carotid artery stenting (CAS) has increasingly emerged as an alternative strategy to carotid endarterectomy in the treatment of patients with symptomatic carotid stenosis. Optimal timing for CAS after symptoms onset remains unclear. We aimed to evaluate the safety and efficacy of CAS when performed in an emergency setting. PATIENTS AND METHODS We performed a retrospective analysis of CAS patients admitted to our CSC with symptomatic extracranial carotid occlusion or significant stenosis from January 2014-September 2019. Emergency CAS was defined as CAS performed during the same hospitalization from TIA/stroke onset, whereas elective CAS as CAS performed on a subsequent admission. The primary outcome was defined as the occurrence of any stroke, myocardial infarction, or death related to the procedure at 3 months of follow-up. Secondary outcomes included periprocedural complications and the rate of restenosis/occlusion at follow-up. Logistic regression and survival analyses were used to compare outcomes and restenosis at follow-up. RESULTS We identified 75 emergency and 104 elective CAS patients. Emergency CAS patients had significantly higher rates of ipsilateral carotid occlusion (17% vs. 2%, p < 0.001) and use of general anesthesia (19% vs. 4%, p = 0.001) than elective CAS. There were no significant differences between emergency and elective CAS in the primary (5.7% vs. 1%, p = 0.161) and secondary (9% vs. 4.8%, p = 0.232) outcomes. We did not find differences in the rate of restenosis/occlusion (7% vs. 11.6%; log-rank test p = 0.3) at a median of 13 months follow-up. CONCLUSION In our study, emergency CAS in symptomatic patients might have a similar safety and efficacy profile to elective CAS at 3 months and long-term follow-up.
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Affiliation(s)
- Darko Quispe-Orozco
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Kaustubh Limaye
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Cynthia B Zevallos
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Alan Mendez-Ruiz
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sameer Ansari
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Andres Dajles
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Colin Derdeyn
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Fu Z, Xu C, Liu X, Wang Z, Gao L. Safety and Efficacy of Tirofiban in Acute Ischemic Stroke Patients Receiving Endovascular Treatment: A Meta-Analysis. Cerebrovasc Dis 2020; 49:442-450. [DOI: 10.1159/000509054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 05/30/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives: Tirofiban is widely used in clinical practice for acute ischemic stroke (AIS). However, whether tirofiban increases the bleeding risk or improves the outcome of AIS patients with endovascular treatment (ET) is unknown. The aim of this meta-analysis is to evaluate the safety and efficacy of tirofiban compared with those without tirofiban in AIS patients receiving ET. Methods: Systematic literature search was done in PubMed and EMBASE databases without language or time limitation. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. Efficacy outcomes were recanalization rate and favorable functional outcome. Review Manager 5.3 and Stata Software Package 15.0 were used to perform the meta-analysis. Results: Eleven studies with a total of 2,028 patients were included. A total of 704 (34.7%) patients were administrated tirofiban combined with ET. Meta-analysis suggested that tirofiban did not increase the risk of sICH (odds ratio (OR) 1.08; 95% confidence interval (CI) 0.81–1.46; p = 0.59) but significantly decreased mortality (OR 0.68; 95% CI 0.52–0.89; p = 0.005). There was no association between tirofiban and recanalization rate (OR 1.26; 95% CI 0.86–1.82; p = 0.23) or favorable functional outcome (OR 1.21; 95% CI 0.88–1.68; p = 0.24). Subgroup analyses indicated that preoperative tirofiban significantly increase recanalization rate (OR 3.89; 95% CI 1.70–8.93; p = 0.001) and improve favorable functional outcome (OR 2.30; 95% CI 1.15–4.60; p = 0.02). Conclusions: Tirofiban is safe in AIS patients with ET and can significantly reduce mortality; preoperative tirofiban may be effective, but further studies are needed to confirm the efficacy.
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12
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Gong J, Shang J, Yu H, Wan Q, Su D, Sun Z, Liu G. Tirofiban for acute ischemic stroke: systematic review and meta-analysis. Eur J Clin Pharmacol 2020; 76:475-481. [DOI: 10.1007/s00228-019-02817-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 12/05/2019] [Indexed: 12/21/2022]
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13
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Niu J, Ding Y, Zhai T, Ju F, Lu T, Xue T, Yin D, Fang D, Chen H, Zhao G. The efficacy and safety of tirofiban for patients with acute ischemic stroke: A protocol for systematic review and a meta-analysis. Medicine (Baltimore) 2019; 98:e14673. [PMID: 30817594 PMCID: PMC6831216 DOI: 10.1097/md.0000000000014673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The clinical use of tirofiban remains controversial for patients with acute ischemic stroke (AIS), we aimed to conduct a meta- analysis of cohort studies to assess the efficacy and safety of tirofiban for AIS patients. METHODS All apparently unconfounded randomized controlled trials (RCTs) and case-controlled studies, with or without blinding, of tirofiban in individuals with AIS will be included in this review. We will conduct a literature search in 2 databases Pubmed and Embase, using indexing terms related to cerebral infarctions and tirofiban to include articles indexed as of Jan 31, 2019 in the English language only. Two reviewers will independently select trials for inclusion and assess trial quality. Two pairs of review authors will independently extract information for each included trials. Primary outcomes are any intracerebral hemorrhage (aICH), symptomatic intracranial hemorrhage (sICH), fatal ICH, recanalization rate and long-term outcome. The risk of bias of the included studies will be evaluated based on Cochrane assessment tool. Revman 5.3 will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis. RESULT We will provide practical and targeted results assessing the efficacy and safety of tirofiban for AIS patients, to provide reference for clinical use of tirofiban. CONCLUSION The stronger evidence about the efficacy and safety of tirofiban for AIS patients will be provided for clinicians.
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Affiliation(s)
| | | | | | - Feng Ju
- Department of Clinical Pharmacy
| | - Tong Lu
- Department of Clinical Pharmacy
| | | | | | | | - Hongjun Chen
- Department of Pharmacy, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jiangsu, China
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