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Aging and disease    2019, Vol. 10 Issue (5) : 1049-1057     DOI: 10.14336/AD.2018.0922
Orginal Article |
Intravenous Administration of Standard Dose Tirofiban after Mechanical Arterial Recanalization is Safe and Relatively Effective in Acute Ischemic Stroke
Zhe Cheng1, Xiaokun Geng1,2,3,*, Jie Gao1, Mohammed Hussain4, Seong-Jin Moon3, Huishan Du1, Yuchuan Ding3,*
1Department of Neurology, Beijing Luhe Hospital, Capital Medical University, China
2China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
3Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
4Department of Neurointerventional Surgery, Hartford Hospital, CT 06106, USA
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To investigate the safety and efficacy of intravenous administration of a standard dose of glycoprotein-IIb/IIIa inhibitor tirofiban after vessel recanalization by mechanical thrombectomy in acute ischemic stroke. A consecutive series of patients (n=112) undergoing endovascular ischemic stroke intervention therapy were enrolled. 81 patients were eligible for intravenous (IV) tirofiban treatment for 24 hours after mechanical thrombectomy. The incidence of symptomatic intracranial hemorrhage (sICH), death, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) were assessed. In the 81 patients receiving tirofiban, 52 patients (64.2%) were treated with IV rt-PA before mechanical thrombectomy. sICH was found in 2 (2.5%) patients with no fatal ICH. Four patients died during 3 months after stroke onset. Successful recanalization with thrombolysis in cerebral infarction (TICI) score ≥2b was achieved in 75 of 81 patients (92.6%) after mechanical thrombectomy. The average number of passes with Solitaire stent retriever was 1.3. At 3 months, 55 of 81 patients (67.9%) had favorable outcomes (mRS<=2). The intravenous application of a standard dose of tirofiban post-Solitaire stent retriever thrombectomy and intravenous thrombolysis appears to be safe and relatively effective in acute ischemic stroke.

Keywords mechanical thrombectomy      Solitaire stent      GP-IIb/IIIa inhibitor      standard dose      intracerebral hemorrhage      vessel recanalization     
Corresponding Authors: Geng Xiaokun,Ding Yuchuan   
About author:

These authors contributed equally to this study.

Just Accepted Date: 26 September 2018   Issue Date: 27 September 2019
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Cheng Zhe
Geng Xiaokun
Gao Jie
Hussain Mohammed
Moon Seong-Jin
Du Huishan
Ding Yuchuan
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Cheng Zhe,Geng Xiaokun,Gao Jie, et al. Intravenous Administration of Standard Dose Tirofiban after Mechanical Arterial Recanalization is Safe and Relatively Effective in Acute Ischemic Stroke[J]. Aging and disease, 2019, 10(5): 1049-1057.
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Figure 1.  Flowchart of Study.
Figure 2.  Mechanical thrombectomy procedures. A) DSA reveals persistent L-MCA M2 occlusion segment and fresh thrombus on the occluded segment. B) Lateral view of L-MCA M2 occlusion segment and fresh thrombus on the occluded segment. C) Deployed SolitaireFR retriever (distal and proximal markers: black arrow). D) After one pass with SolitaireFR retriever, successful recanalization was achieved (TICI 3). E: Lateral view of L-MCA after successful vessel recanalization. F) The fresh thrombus removed by SolitaireFR retriever.
ALL patients
Age, median (range)64.0 (30,81)64.6 (30,81)
Sex ratio (male/female)55/2671/41
NIHSS at onset, median (range)18 (9,26)18 (9,30)
ASPECTS, median (range)8.9 (6,10)8.4 (6,10)
Risk factors, n (%)
Hypertension64 (79.0)88 (78.6.)
Diabetes mellitus18 (22.2)24 (21.4)
Atrial fibrillation26 (32.1)31 (27.7)
Smoking25 (30.9)39 (34.8)
Occlusion site, n (%)
M144 (54.3)55 (49.1)
T-ICA9 (11.1)16 (14.3)
P-ICA9 (11.1)15 (13.4)
BA19 (23.5)26 (23.2)
rt-PA, n (%)52 (64.2)71 (63.4)
Stent, n (%)18 (22.2)28 (25.0)
NOP, median (min, range)1.3 (1,4)1.3 (1,4)
TOR, median (range)56 (27,125)57 (27,125)
TTR, median (min, range)275(60,790)271 (60,790)
Reocclusion (%)3 (3.7)-
Table 1  Demographic and clinical characteristics of patient with tirofiban and all patients.
1-week NIHSSICHsICHFatal ICH3-month
mRS (0-2)
3-month death
Tirofiban (n=81)92.6%77.4%2.5%067.9%4.9%
All patients (n=112)87.5%78.0%4.5%1.8%61.6%12.5%
Five RCT58.7-86%_-0-7.7%_32.6-71.4%9-21%
Table 2  Clinical outcomes of tirofiban and all patients versus five large randomized control trials.
ICH(n=6)no-ICH(n=75)P Value
Age (mean ±SD)63.3±10.864.7±10.60.871
Hypertension (n, %)5(83.3%)59 (79.7%)1.0 (Continuity correction)
NIHSS at onset (mean ±SD)18±4.417±4.70.933
Occlusion (anterior/posterior)6/056/190.161 (Fisher)
Stent (n, %)2 (28.6)16(21.3)
IV rt-PA2 (28.6)50 (66.7)0.232 (Continuity correction)
NOP (mean ±SD)1.2±0.41.3±0.60.522
TOR (min, mean ±SD)74±2055±220.048*
TTR (min, mean ±SD)220±50279±1270.260
Table 3  The demographic and clinical characteristics between ICH and no-ICH patients.
ICH (n=6)no-ICH (n=56)P Value
ASPECT in anterior circulation stroke(mean ±SD)7.7±1.88.7±1.00.045*
Table 4  ASPECT Score in anterior circulation stroke between ICH and no-ICH patients.
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