Hyperacute Stenting for Acute Ischemic Stroke Is Associated with a High Rate of Symptomatic Intracranial Hemorrhage (P02.200)

Association of tirofiban treatment with outcomes following endovascular therapy in cardioembolic stroke: insights from the RESCUE BT randomized trial

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.

[Treatment of acute tandem occlusion of arteries of anterior cerebral circulation without emergency stenting]

The article deals with problems of endovascular treatment of acute tandem and isolated occlusions of arteries of the anterior cerebral circulation, as well as the problem of reocclusions and new occlusions of these target arteries in the early postoperative period after thrombectomy.

PURPOSE

To determine the effect of reocclusions and new, previously not identified occlusions of the carotid artery and middle cerebral artery after cerebral thrombectomy on the outcomes of ischaemic stroke, as well as to substantiate feasibility of endovascular policy without simultaneous carotid stenting in thrombectomy in case of tandem occlusions of arteries of the anterior cerebral circulation.

PATIENTS AND METHODS

We studied the results of endovascular treatment of 52 patients with acute ischaemic stroke, including 26 patients with combined occlusions of the internal carotid and middle cerebral arteries (group 1) and 26 patients with isolated occlusion of the M1 segment of the middle cerebral artery or its equivalent (group 2). The groups were compared using the Chi-squared and Mann-Whitney test, and the effect of the factors was assessed by calculating the relative risk.

RESULTS

Disability of patients in group 1 was significantly two-fold higher as compared with group 2. Differences in mortality and frequency of a good functional outcome (0-2 points on the Rankin scale) were, on the contrary, insignificant. Reocclusion of the internal carotid artery demonstrated no significant influence on outcomes of the disease in combined type of the lesion. Reocclusion of the target vessel after thrombectomy significantly decreased the probability of a good functional outcome in patients 1.7-fold (p<0.05), as well as increased the relative risk of disability 4-fold in initially isolated occlusion of the middle cerebral artery (p<0.05).

CONCLUSION

Surgical policy aimed at thrombectomy from the middle cerebral artery in the presence of tandem occlusions of the internal carotid artery and middle cerebral artery without emergency carotid stenting is safe and efficient in acute period of ischaemic stroke. Reocclusion of the middle cerebral artery after performed thrombectomy related to its isolated occlusion increased the probability of patients' disability. Newly identified in the postoperative period occlusion of the internal carotid artery in thrombectomy from the middle cerebral artery also increased the risk of disability.