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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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Abstract  

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
Cite this article:   
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.
URL:  
http://www.aginganddisease.org/EN/10.14336/AD.2018.0922     OR     http://www.aginganddisease.org/EN/Y2019/V10/I5/1049
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.
Tirofiban
(n=81)
ALL patients
(n=112)
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.
TICI
≥2b
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.
[1] Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, et al. (2014). Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet, 384:1929-1935.
[2] WuChuanjie. DW, JianChen., Chuanhui Li, Xunming Ji (2018). Why not Intravenous Thrombolysis in Patients with Recurrent Stroke within 3 Months? Aging Disease, 9:309-316.
[3] Konark Malhotra DSL (2016). Wake-up stroke: Dawn of a new era. Brain Circulation, 2:72-79.
[4] Liu X, Pu Y, Pan Y, Zhang Y, Dou X, Tan Y, et al. (2016). Multi-mode ct in the evaluation of leptomeningeal collateral flow and the related factors: Comparing with digital subtraction angiography. Neurological research. 38:504-509
[5] Penumbra Pivotal Stroke Trial I (2009). The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke, 40:2761-2768.
[6] Meyers PM, Schumacher HC, Connolly ESJr, Heyer EJ, Gray WA, Higashida RT (2011). Current status of endovascular stroke treatment. Circulation, 123:2591-2601.
[7] Gary B Rajah HS, Ali Luqman, Sandra Narayanan (2018). Impact of expanding large vessel occlusion thrombectomy time-windows in inner city Detroit. Brain Circulation, 4:76-78.
[8] Hafeez A, Liu L, Ding Y (2016). Ongoing progress and new developments in the clinical approach to stroke and cerebrovascular disease: New paradigms: A novel outlook into stroke. Neurological research. 38:477
[9] Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, et al. (2015). Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med, 372:2285-2295.
[10] Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, et al. (2015). Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med, 372:2296-2306.
[11] Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. (2015). Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med, 372:1019-1030.
[12] Campbell BC, Mitchell PJ, Kleinig TJ, Dewey HM, Churilov L, Yassi N, et al. (2015). Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med, 372:1009-1018.
[13] Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ, et al. (2015). A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med, 372:11-20.
[14] Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. (2015). 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 46:3020-3035.
[15] Badhiwala JH, Nassiri F, Alhazzani W, Selim MH, Farrokhyar F, Spears J, et al. (2015). Endovascular Thrombectomy for Acute Ischemic Stroke: A Meta-analysis. JAMA, 314:1832-1843.
[16] Enomoto Y, Yoshimura S, Egashira Y, Takagi T, Tsujimoto M, Iwama T (2014). Long-term magnetic resonance angiography follow-up for recanalized vessels after mechanical thrombectomy. J Stroke Cerebrovasc Dis, 23:2834-2839.
[17] Kellert L, Hametner C, Rohde S, Bendszus M, Hacke W, Ringleb P, et al. (2013). Endovascular stroke therapy: tirofiban is associated with risk of fatal intracerebral hemorrhage and poor outcome. Stroke, 44:1453-1455.
[18] Hu H, Doll DN, Sun J, Lewis SE, Wimsatt JH, Kessler MJ, et al. (2016). Mitochondrial Impairment in Cerebrovascular Endothelial Cells is Involved in the Correlation between Body Temperature and Stroke Severity. Aging Dis, 7:14-27.
[19] Siebler M, Hennerici MG, Schneider D, von Reutern GM, Seitz RJ, Rother J, et al. (2011). Safety of Tirofiban in acute Ischemic Stroke: the SaTIS trial. Stroke, 42:2388-2392.
[20] Li W, Lin L, Zhang M, Wu Y, Liu C, Li X, et al. (2016). Safety and Preliminary Efficacy of Early Tirofiban Treatment After Alteplase in Acute Ischemic Stroke Patients. Stroke, 47:2649-2651.
[21] Wu C, Wu D, Chen J, Li C, Ji X (2018). Why not Intravenous Thrombolysis in Patients with Recurrent Stroke within 3 Months? Aging Dis, 9:309-316.
[22] Kleinschnitz C, Pozgajova M, Pham M, Bendszus M, Nieswandt B, Stoll G (2007). Targeting platelets in acute experimental stroke: impact of glycoprotein Ib, VI, and IIb/IIIa blockade on infarct size, functional outcome, and intracranial bleeding. Circulation, 115:2323-2330.
[23] Kang DH, Kim YW, Hwang YH, Park SP, Kim YS, Baik SK (2014). Instant reocclusion following mechanical thrombectomy of in situ thromboocclusion and the role of low-dose intra-arterial tirofiban. Cerebrovasc Dis, 37:350-355.
[24] Seo JH, Jeong HW, Kim ST, Kim EG (2015). Adjuvant Tirofiban Injection Through Deployed Solitaire Stent As a Rescue Technique After failed Mechanical Thrombectomy in Acute Stroke. Neurointervention, 10:22-27.
[25] Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, et al. (1998). Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet, 352:1245-1251.
[26] Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. (2016). Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet, 387:1723-1731.
[27] Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. (2018). Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med, 378:11-21.
[28] Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. (2018). Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med, 378:708-718.
[29] Kraft P, Schuhmann MK, Fluri F, Lorenz K, Zernecke A, Stoll G, et al. (2015). Efficacy and Safety of Platelet Glycoprotein Receptor Blockade in Aged and Comorbid Mice With Acute Experimental Stroke. Stroke, 46:3502-3506.
[30] Ciccone A, Motto C, Abraha I, Cozzolino F, Santilli I (2014). Glycoprotein IIb-IIIa inhibitors for acute ischaemic stroke. Cochrane Database Syst Rev:CD005208.
[31] Kim JW, Jeon P, Kim GM, Bang OY, Byun HS, Kim KH (2012). 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, 114:1316-1319.
[32] Kwon JH, Shin SH, Weon YC, Hwang JC, Baik SK (2011). Intra-arterial adjuvant tirofiban after unsuccessful intra-arterial thrombolysis of acute ischemic stroke: preliminary experience in 16 patients. Neuroradiology, 53:779-785.
[33] Mangiafico S, Cellerini M, Nencini P, Gensini G, Inzitari D (2005). Intravenous glycoprotein IIb/IIIa inhibitor (tirofiban) followed by intra-arterial urokinase and mechanical thrombolysis in stroke. AJNR Am J Neuroradiol, 26:2595-2601.
[34] Bogdahn U, Schlachetzki F, Schuierer G (2013). Letter by Schlachetzki et al regarding article, "endovascular stroke therapy: tirofiban is associated with risk of fatal intracerebral hemorrhage and poor outcome". Stroke, 44:e112.
[35] Hussain M, Datta N, Cheng Z, Dornbos D3rd, Bashir A, Sultan I, et al. (2017). Spanning from the West to East: An Updated Review on Endovascular Treatment of Intracranial Atherosclerotic Disease. Aging Dis, 8:196-202.
[36] Yoo AJ, Zaidat OO, Chaudhry ZA, Berkhemer OA, Gonzalez RG, Goyal M, et al. (2014). Impact of pretreatment noncontrast CT Alberta Stroke Program Early CT Score on clinical outcome after intra-arterial stroke therapy. Stroke, 45:746-751.
[37] Zhao W, Che R, Shang S, Wu C, Li C, Wu L, et al. (2017). Low-Dose Tirofiban Improves Functional Outcome in Acute Ischemic Stroke Patients Treated With Endovascular Thrombectomy. Stroke, 48:3289-3294.
[38] Juwana YB, Suryapranata H, Ottervanger JP, van 't Hof AW (2010). Tirofiban for myocardial infarction. Expert Opin Pharmacother, 11:861-866.
[39] Marmur JD, Poludasu S, Agarwal A, Manjappa N, Cavusoglu E (2008). High-dose tirofiban administered as bolus-only during percutaneous coronary intervention. J Invasive Cardiol, 20:53-58.
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