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Abstract
Background and Objective To investigate the efficacy and safety of IV infusion of tirofiban before endovascular thrombectomy for patients with large vessel occlusion due to intracranial atherosclerotic disease. The secondary objective was to identify potential mediators for the clinical effect of tirofiban.
Methods Post hoc exploratory analysis of the Endovascular Treatment With versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke (RESCUE BT) trial, which was a randomized, double-blinded, placebo-controlled trial at 55 centers in China from October 2018 to October 2021. Patients with occlusion of the internal carotid artery or middle cerebral artery due to intracranial atherosclerosis were included. The primary efficacy outcome was the proportion of patients achieving functional independence (defined as modified Rankin scale 0–2) at 90 days. Binary logistic regression and causal mediation analyses were used to estimate the treatment effect of tirofiban and the potential mediators.
Results This study included 435 patients, of whom 71.5% were men. The median age was 65 (interquartile range [IQR] 56–72) years, with a median NIH Stroke Scale of 14 (IQR 10–19). Patients in the tirofiban group had higher rates of functional independence at 90 days than patients in the placebo group (adjusted odds ratio 1.68; 95% CI 1.11–2.56, p = 0.02) without an increased risk of mortality or symptomatic intracranial hemorrhage. Tirofiban was associated with fewer thrombectomy passes (median [IQR] 1 [1–2] vs 1 [1–2], p = 0.004), which was an independent predictor of functional independence. Mediation analysis showed tirofiban-reduced thrombectomy passes explained 20.0% (95% CI 4.1%–76.0%) of the effect of tirofiban on functional independence.
Discussion In this post hoc analysis of the RESCUE BT trial, tirofiban was an effective and well-tolerated adjuvant medication of endovascular thrombectomy for patients with large vessel occlusion due to intracranial atherosclerosis. These findings need to be confirmed in future trials.
Trial Registration Information The RESCUE BT trial was registered on the Chinese Clinical Trial Registry: chictr.org.cn, ChiCTR-INR-17014167.
Classification of Evidence This study provides Class II evidence that tirofiban plus endovascular therapy improves 90-day outcome for patients with large vessel occlusion due to intracranial atherosclerosis.
Glossary
- aOR=
- adjusted OR;
- ASPECTS=
- Alberta Stroke Program Early CT Score;
- EVT=
- endovascular therapy;
- ICA=
- internal carotid artery;
- ICAD=
- intracranial atherosclerotic disease;
- ICH=
- intracranial hemorrhage;
- IQR=
- interquartile range;
- ITT=
- intention-to-treat;
- IVT=
- IV thrombolysis;
- LVO=
- large vessel occlusive;
- M1 MCA=
- MCA M1 segment;
- M2 MCA=
- MCA M2 segment;
- MCA=
- middle cerebral artery;
- mRS=
- modified Rankin scale;
- NIHSS=
- NIH Stroke Scale;
- OR=
- odds ratio;
- RESCUE BT=
- Endovascular Treatment With versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke;
- sICH=
- symptomatic ICH
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Editor-in-Chief José Merino, MD, MPhil, FAAN.
Class of Evidence: NPub.org/coe
- Received October 7, 2022.
- Accepted in final form February 1, 2023.
- © 2023 American Academy of Neurology
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