There is no difference in safety and efficacy mechanical thrombectomy alone or mechanical thrombectomy with tirofiban for patients undergoing treatment of large vessel occlusion and underlying intracranial atherosclerosis

• Published in: Interdisciplinary neurosurgery : Advanced techniques and case management Vol. 27; p. 101383
• Main Authors: Movva, Hari, Rabah, Rani, Tekle, Wondwossen, Preston, Laurie, Kotta, Hari, Hassan, Ameer E
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-03-2022; Elsevier
• Subjects: Acute ischemic stroke intervention; ICH; Mechanical thrombectomy; MRS; Recanalization; Recanalization; Acute ischemic stroke intervention; Mechanical thrombectomy; ICH; MRS
• ISSN: 2214-7519; 2214-7519
• DOI: 10.1016/j.inat.2021.101383

Mechanical thrombectomy (MT) is a widely proven method to treat acute ischemic stroke (AIS) during mechanical thrombectomy and acute stenting and angioplasty is a topic discussed till this day regarding safety and efficacy. However, intravenous glycoprotein IIb/IIIa agents such as Tirofiban have become a more common thing. We report the analysis of all AIS patients treated with Tirofiban + MT vs. MT alone.
Using a prospectively collected endovascular database at a CSC between 2013 and 2019, workflow, and outcomes were recorded. Patients are given Tirofiban undergoing mechanical thrombectomy and patients undergoing mechanical thrombectomy alone were analyzed to obtain baseline demographics, modified Ranking Scale (mRS) at discharge, and 90 days follow up, pre and post thrombolysis in cerebral infarction (TICI), mortality rate, and hemorrhage rates.
There was a total of 169 patients during the study period (average age 68.18 ± 14, 41.42% female). Analysis of 36 patients from the Tirofiban + MT group (average age 69.25 ± 14.18, 27.77% female), and 133 patients from the MT alone was performed (average age 67.89 ± 13.99, 45.11%), see Table 3 for baseline characteristics and outcomes. Four patients (11.11%) in the Tirofiban + MT group had symptomatic hemorrhage versus fourteen patients (10.53%) in the MT alone group (p = .919). There was no significant difference in mortality between the two groups (p = .622).
Tirofiban in addition to MT does not increase the risk of symptomatic hemorrhage or mortality. More extensive studies are warranted to prove the safety and efficacy of tirofiban and MT in AIS with tandem lesions.