The Safety of Intra-arterial Tirofiban during Endovascular Therapy after Intravenous Thrombolysis

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FIG 1.
Study flow chart. The Acute Stroke due to Intracranial Atherosclerotic occlusion and Neurointervention-Korean Retrospective (ASIAN KR) registry. ACA indicates anterior cerebral artery; PCA, posterior cerebral artery; VBA, vertebrobasilar artery.
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FIG 2.
Subgroup analysis for postprocedural reocclusion in patients with mTICI ≥2a. In Embolic-O, postprocedrual reocclusion is 2.0% in patients without IA tirofiban and 7.7% in those with IA tirofiban. Patients with ICAS-O with IA tirofiban tend to have less postprocedural reocclusion than those without IA tirofiban (no tirofiban, 17.4%, versus tirofiban, 0.0%). Embolic-O indicates embolic occlusion.

Table 1:

Baseline characteristics of patients

	No Tirofiban (n = 279)	Tirofiban (n = 35)	P Value
Age (median) (IQR) (yr)	69.0 (60.0–76.0)	66.0 (55.5–73.0)	.163
Sex (male)	144 (51.6%)	24 (68.6%)	.086
Hypertension	174 (62.4%)	18 (51.4%)	.286
DM	60 (21.5%)	9 (25.7%)	.726
Hyperlipidemia	75 (26.9%)	12 (34.3%)	.470
Prior antiplatelet	89 (31.9%)	7 (20.0%)	.213
Prior anticoagulant	29 (10.4%)	1 (2.9%)	.261
NIHSS on admission (median) (IQR)	17.0 (13.0–20.0)	16.0 (12.0–20.0)	.448
Onset-to-puncture time (min, median) (IQR)	204.0 (153.0–257.5)	184.0 (150.0–281.5)	.622
Onset-to-final angiography time (min, median) (IQR)	273.0 (214.5–349.0)	303.0 (241.0–348.5)	.230
Etiology of LVO			<.001
Embolic occlusion	231 (82.8%)	16 (45.7%)
ICAS occlusion	28 (10.0%)	18 (51.4%)
Intractable (failed thrombectomy)	20 (7.2%)	1 (2.9%)
Target artery occlusion			.725
Terminal ICA	113 (40.5%)	11 (31.4%)
MCA M1	139 (49.8%)	20 (57.1%)
MCA M2	27 (9.7%)	4 (11.4%)
Intraprocedural reocclusion	10 (3.6%)	11 (31.4%)	<.001
Intracranial stent placement	9 (3.2%)	6 (17.1%)	.001
Intracranial ballooning	8 (2.9%)	0 (0.0%)	.656
ASPECTS (median) (IQR)	7.0 (4.0–9.0)	8.0 (4.5–9.5)	.899

Note:—IQR indicates interquartile range; DM, diabetes mellitus; ICAS, intracranial atherosclerotic stenosis.

Table 2:

Patient safety and efficacy outcomes

	No tirofiban (n = 279)	Tirofiban (n = 35)	Unadjusted	Adjusted^{^a}	P value
	No tirofiban (n = 279)	Tirofiban (n = 35)	OR (95% CI)	OR (95% CI)	Unadjusted/Adjusted^{^a}
Successful reperfusion	210 (75.3%)	28 (80.0%)	1.31 (0.57−3.38)	1.56 (0.53 to 5.34)	.684/.440
Postprocedural reocclusion^{^b}	11 (4.4%)	1 (2.9%)	0.65 (0.03−3.52)	0.19 (0.01−1.30)	.688/.151
3-month good outcome	150 (53.8%)	20 (57.1%)	1.14 (0.56−2.36)	2.22 (0.89−6.12)	.843/.099
3-month death	35 (12.5%)	2 (5.7%)	0.42 (0.06−1.47)	0.38 (0.04−1.87)	.366/.299
Serious hemorrhage	31 (11.1%)	3 (8.6%)	0.75 (0.17−2.25)	1.07 (0.20−4.10)	.867/.918
IVH	19 (6.8%)	1 (2.9%)	0.04 (0.02−2.03)	0.43 (0.02−2.85)	.592/.467

Note:—IVH indicates intraventricular hemorrhage; OR, Odds ratio.
↵a Adjusted for sex, intraprocedural reocclusion, intracranial stenting, etiology of large vessel occlusion.
↵b Postprocedural reocclusion was assessed in 248 patients (no tirofiban group) and in 34 patients (tirofiban group).