Generic placeholder image

Current Neurovascular Research


ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Research Article

Safety and Efficacy of Intra-arterial Tirofiban Injection During Mechanical Thrombectomy for Large Artery Occlusion

Author(s): Ho J. Yi , Jae H. Sung* and Dong H. Lee

Volume 16 , Issue 5 , 2019

Page: [416 - 424] Pages: 9

DOI: 10.2174/1567202616666191023154956

Price: $65


Objective: The safety and effect of intra-arterial (IA) tirofiban, a glycoprotein IIb/IIIa inhibitor, during the stent retriever mechanical thrombectomy (MT) was investigated.

Methods: From January 2015 to May 2019, a total of 327 patients underwent mechanical thrombectomy of large artery occlusions (LAO). Patients were classified into two groups: MT with IA tirofiban (MTT) group and MT only (MTO, without IA tirofiban) group. Clinical outcomes, radiological results, and various complications, such as post thrombectomy hemorrhage, symptomatic hemorrhage, other systemic bleeding, and hemorrhagic transformation of infarct were evaluated by comparing the MTT group and MTO group. In addition, subgroup analysis was performed for patients who underwent MT with prior intravenous (IV) tissue plasminogen activator (t-PA).

Results: The MTT group needed a lower mean number of stent passes and showed a re-occlusion rate as compared with the MTO group (P=0.038 and 0.022, respectively). Between the two groups, there were no statistically significant differences in post thrombectomy hemorrhage, symptomatic hemorrhage, other systemic bleeding complications, or hemorrhagic transformation of infarct (P = 0.511, 0.397, 0.429, and 0.355, respectively). In the subgroup analysis, similar findings were observed.

Conclusion: The use of IA tirofiban during MT seems to be safe and potentially more effective than only MT without IA tirofiban, even in patients who used IV t-PA before MT.

Keywords: Ischemic stroke, tirofiban, tissue plasminogen activator, thrombectomy, thrombolysis, thrombosis.

Berkhemer OA, Fransen PS, Beumer D, et al. MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372(1): 11-20.
[] [PMID: 25517348]
Campbell BC, Mitchell PJ, Kleinig TJ, et al. EXTEND-IA Investigators. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372(11): 1009-18.
[] [PMID: 25671797]
Saver JL, Goyal M, Bonafe A, et al. SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372(24): 2285-95.
[] [PMID: 25882376]
Goyal M, Demchuk AM, Menon BK, et al. ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372(11): 1019-30.
[] [PMID: 25671798]
Jovin TG, Chamorro A, Cobo E, et al. REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372(24): 2296-306.
[] [PMID: 25882510]
Bracard S, Ducrocq X, Mas JL, et al. THRACE investigators. Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): A randomised controlled trial. Lancet Neurol 2016; 15(11): 1138-47.
[] [PMID: 27567239]
Gory B, Armoiry X, Sivan-Hoffmann R, et al. A direct aspiration first pass technique for acute stroke therapy: A systematic review and meta-analysis. Eur J Neurol 2018; 25(2): 284-92.
[] [PMID: 29053904]
Phan K, Dmytriw AA, Teng I, et al. A direct aspiration first pass technique vs. standard endovascular therapy for acute stroke: A systematic review and meta-analysis. Neurosurgery 2018; 83(1): 19-28.
[] [PMID: 28973527]
Wang Y, Zhao X, Liu L, et al. CICAS Study Group. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: The Chinese Intracranial Atherosclerosis (CICAS) Study. Stroke 2014; 45(3): 663-9.
[] [PMID: 24481975]
Leischner H, Flottmann F, Hanning U, et al. Reasons for failed endovascular recanalization attempts in stroke patients. J Neurointerv Surg 2019; 11(5): 439-42.
[] [PMID: 30472671]
Yoon W, Kim SK, Park MS, Kim BC, Kang HK. Endovascular treatment and the outcomes of atherosclerotic intracranial stenosis in patients with hyperacute stroke. Neurosurgery 2015; 76(6): 680-6.
[] [PMID: 25988927]
Zhao H, Zhang J, Gu D, et al. Tirofiban facilitates the reperfusion process during endovascular thrombectomy in ICAS. Exp Ther Med 2017; 14(4): 3314-8.
[] [PMID: 28912883]
Jeong HW, Jin SC. Intra-arterial infusion of a glycoprotein IIb/IIIa antagonist for the treatment of thromboembolism during coil embolization of intracranial aneurysm: A comparison of abciximab and tirofiban. AJNR Am J Neuroradiol 2013; 34(8): 1621-5.
[] [PMID: 23660289]
Kwon JH, Shin SH, Weon YC, Hwang JC, Baik SK. Intra-arterial adjuvant tirofiban after unsuccessful intra-arterial thrombolysis of acute ischemic stroke: Preliminary experience in 16 patients. Neuroradiology 2011; 53(10): 779-85.
[] [PMID: 21808986]
Chalouhi N, Jabbour P, Kung D, Hasan D. Safety and efficacy of tirofiban in stent-assisted coil embolization of intracranial aneurysms. Neurosurgery 2012; 71(3): 710-4.
[] [PMID: 22668886]
van ’t Hof AW, Valgimigli M. Defining the role of platelet glycoprotein receptor inhibitors in STEMI: Focus on tirofiban. Drugs 2009; 69(1): 85-100.
[] [PMID: 19192938]
Cho YD, Lee JY, Seo JH, et al. Intra-arterial tirofiban infusion for thromboembolic complication during coil embolization of ruptured intracranial aneurysms. Eur J Radiol 2012; 81(10): 2833-8.
[] [PMID: 22683194]
Kim JW, Jeon P, Kim GM, Bang OY, Byun HS, Kim KH. Local intraarterial tirofiban after formation of anterograde flow in patients with acute ischemic stroke: Preliminary experience and short term follow-up results. Clin Neurol Neurosurg 2012; 114(10): 1316-9.
[] [PMID: 22633401]
Hacke W, Kaste M, Bluhmki E, et al. ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359(13): 1317-29.
[] [PMID: 18815396]
Delgado Almandoz JE, Kayan Y, Young ML, et al. Comparison of clinical outcomes in patients with acute ischemic strokes treated with mechanical thrombectomy using either Solumbra or ADAPT techniques. J Neurointerv Surg 2016; 8(11): 1123-8.
[] [PMID: 26667250]
Mandava P, Thiagarajan P, Kent TA. Glycoprotein IIb/IIIa antagonists in acute ischaemic stroke: Current status and future directions. Drugs 2008; 68(8): 1019-28.
[] [PMID: 18484795]
Manoharan G, Adgey AA. Considerations in combination therapy: fibrinolytics plus glycoprotein IIb/IIIa receptor inhibitors in acute myocardial infarction. Clin Cardiol 2004; 27(7): 381-6.
[] [PMID: 15298036]
Szabo S, Walter T, Etzel D, et al. Benefical effects of reteplase in combination with abciximab: Platelet/leukocyte interactions and coagulation system. Int J Clin Pharmacol Res 2003; 23(2-3): 37-40.
[PMID: 15018016]
Philipps J, Thomalla G, Glahn J, Schwarze M, Rother J. Treatment of progressive stroke with tirofiban--experience in 35 patients. Cerebrovasc Dis 2009; 28(5): 435-8.
[] [PMID: 19738371]
Hwang YH, Kim YW, Kang DH, Kim YS, Liebeskind DS. Impact of target arterial residual stenosis on outcome after endovascular revascularization. Stroke 2016; 47(7): 1850-7.
[] [PMID: 27174525]
Seitz RJ, Sukiennik J, Siebler M. Outcome after systemic thrombolysis is predicted by age and stroke severity: An open label experience with recombinant tissue plasminogen activator and tirofiban. Neurol Int 2012; 4(2)e9
[] [PMID: 23139853]
Goh DH, Jin SC, Jeong HW, Ha SY. Mechanical solitaire thrombectomy with low-dose booster Tirofiban injection. Neurointervention 2016; 11(2): 114-9.
[] [PMID: 27621948]
Seo JH, Jeong HW, Kim ST, Kim EG. Adjuvant Tirofiban injection through deployed solitaire stent as a rescue technique after failed mechanical thrombectomy in acute stroke. Neurointervention 2015; 10(1): 22-7.
[] [PMID: 25763294]
Wu C, Sun C, Wang L, et al. Low-dose tirofiban treatment improves neurological deterioration outcome after intravenous thrombolysis Stroke 2019; STROKEAHA119026240
Zhang Y, Zhang QQ, Fu C, et al. Clinical efficacy of tirofiban combined with a Solitaire stent in treating acute ischemic stroke. Braz J Med Biol Res 2019; 52(10)e8396
[] [PMID: 31531525]
Kim S, Choi JH, Kang M, Cha JK, Huh JT. Safety and efficacy of intravenous tirofiban as antiplatelet premedication for stent-assisted coiling in acutely ruptured intracranial aneurysms. AJNR Am J Neuroradiol 2016; 37(3): 508-14.
[] [PMID: 26471748]
Chalouhi N, Jabbour P, Daou B, Starke RM, Shields B, Hasan DM. A new protocol for anticoagulation with tirofiban during flow diversion. Neurosurgery 2016; 78(5): 670-4.
[] [PMID: 26488330]
Liang XD, Wang ZL, Li TX, et al. Safety and efficacy of a new prophylactic tirofiban protocol without oral intraoperative antiplatelet therapy for endovascular treatment of ruptured intracranial aneurysms. J Neurointerv Surg 2016; 8(11): 1148-53.
[] [PMID: 26614492]
Janjua N, Alkawi A, Suri MF, Qureshi AI. Impact of arterial reocclusion and distal fragmentation during thrombolysis among patients with acute ischemic stroke. AJNR Am J Neuroradiol 2008; 29(2): 253-8.
[] [PMID: 18024576]
Kang DH, Kim YW, Hwang YH, Park SP, Kim YS, Baik SK. Instant reocclusion following mechanical thrombectomy of in situ thromboocclusion and the role of low-dose intra-arterial tirofiban. Cerebrovasc Dis 2014; 37(5): 350-5.
[] [PMID: 24941966]
Kellert L, Hametner C, Rohde S, et al. Endovascular stroke therapy: Tirofiban is associated with risk of fatal intracerebral hemorrhage and poor outcome. Stroke 2013; 44(5): 1453-5.
[] [PMID: 23463755]
Baik SK, Oh SJ, Park KP, Lee JH. Intra-arterial tirofiban infusion for partial recanalization with stagnant flow in hyperacute cerebral ischemic stroke. Interv Neuroradiol 2011; 17(4): 442-51.
[] [PMID: 22192548]
Yu T, Lin Y, Jin A, et al. Safety and efficiency of low dose intra-arterial tirofiban in mechanical thrombectomy during acute ischemic stroke. Curr Neurovasc Res 2018; 15(2): 145-50.
[] [PMID: 29875001]
Luo Y, Yang Y, Xie Y, Yuan Z, Li X, Li J. Therapeutic effect of pre-operative tirofiban on patients with acute ischemic stroke with mechanical thrombectomy within 6-24 hours. Interv Neuroradiol 2019; 25(6): 705-9.
[] [PMID: 31112428]
Zhang S, Hao Y, Tian X, et al. Safety of intra-arterial tirofiban administration in ischemic stroke patients after unsuccessful mechanical thrombectomy. J Vasc Interv Radiol 2019; 30(2): 141-7. e1.
Kang DH, Yoon W, Kim SK, et al. Endovascular treatment for emergent large vessel occlusion due to severe intracranial atherosclerotic stenosis. J Neurosurg 2018. [Epub ahead of print]
[] [PMID: 29932374]
Kang DH, Yoon W. Current opinion on endovascular therapy for emergent large vessel occlusion due to underlying intracranial atherosclerotic stenosis. Korean J Radiol 2019; 20(5): 739-48.
[] [PMID: 30993925]

Rights & Permissions Print Export Cite as
© 2022 Bentham Science Publishers | Privacy Policy