Efficacy and safety of tirofiban injection with intracranial stenting in early reocclusion due to intracranial atherosclerosis
- Abstract
- Objective: We aimed to develop an optimal protocol for failed mechanical thrombectomy (MT) in cases of emergent large vessel occlusion (ELVO) with intracranial atherosclerosis (ICAS). Methods: A total of 117 patients without underlying heart disease who were not taking antiplatelet drugs had early reocclusion during MT for ELVO due to ICAS. They were divided into the following 3 groups according to rescue treatment methods: 1) Combined intravenous (IV) + intra-arterial (IA) tirofiban group (n = 48), emergent percutaneous transluminal angioplasty (PTA) and intracranial stenting (ICS) followed by IA injection of tirofiban and a continuous IV tirofiban infusion for 8 h; 2) IA tirofiban group (n = 33), only IA 0.5-1.0 mg tirofiban infusion for 5 min regardless of PTA or ICS; and 3) no tirofiban group (n = 36), no tirofiban injection regardless of PTA or ICS. Results: ICS was more frequently performed in the combined IV + IA tirofiban group than in the IA tirofiban group (100% vs 46%, p < 0.05). The proportion of m-TICI grades 2b and 3 (93.8% vs. 63.6%, p < 0.05), especially the proportion of m-TICI grade 3 (81.3% vs. 36.4%, p < 0.05), was higher in the combined IV + IA tirofiban group than in the IA tirofiban group. The rate of postoperative intracranial hemorrhage was not significantly different among the three groups. The rate of modified Rankin scale scores of 0-2 at 3 months after MT was highest in the combined IV + IA tirofiban group (63%), followed by the IA tirofiban (46%) and no tirofiban groups (8%, p < 0.05). Conclusion: ICS with IA and continuous IV tirofiban injections for 8 h is an effective and safe protocol for failed MT in patients with ELVO with ICAS.
- All Author(s)
- Y. H. Noh
; J. Y. Lee
; S. M. Yoon
; Y. J. Ha
; J. Chung
; J. H. Ko
; D. S. Shin
; J. M. Ahn
; H. J. Oh
; J. J. Shim
; M. R. Lee
; J. S. Oh
- Issued Date
- 2022
- Type
- Article
- Keyword
- Ischemic stroke; Intracranial arteriosclerosis; Thrombectomy; Thrombosis; Tirofiban
- ISSN
- 2214-7519
- Citation Title
- Interdisciplinary Neurosurgery: Advanced Techniques and Case Management
- Citation Volume
- 27
- Citation Start Page
- 101425
- Citation End Page
- 101425
- Language(ISO)
- eng
- DOI
- 10.1016/j.inat.2021.101425
- URI
- http://schca-ir.schmc.ac.kr/handle/2022.oak/3319
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