The following is a summary of “Association of Tirofiban With Functional Outcomes After Thrombectomy in Acute Ischemic Stroke Due to Intracranial Atherosclerotic Disease,” published in the May 2023 issue of Neurology by Sang, et al.
For a study, researchers sought to investigate the efficacy and safety of IV tirofiban infusion for patients with large vessel occlusion due to intracranial atherosclerotic disease before endovascular thrombectomy. The secondary objective was to identify potential mediators for the clinical effect of tirofiban.
For the post hoc exploratory analysis, the researchers used data from the Endovascular Treatment With versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke (RESCUE BT) trial. It was a randomized, double-blinded, placebo-controlled trial conducted in 55 centers from October 2018 to October 2021. The study included patients with occlusion of the internal carotid or middle cerebral artery due to intracranial atherosclerosis. The primary efficacy outcome was the proportion of patients achieving functional independence (defined as a 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.
The study included 435 patients, with a median age of 65 (interquartile range [IQR] 56–72) years and a median NIH Stroke Scale of 14 (IQR 10–19). Of these patients, 71.5% were men. The results showed that 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. In addition, 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 that tirofiban-reduced thrombectomy passes explained 20.0% (95% CI 4.1%–76.0%) of the effect of tirofiban on functional independence.
In conclusion, the results of the post hoc analysis of the RESCUE BT trial suggest that tirofiban was an effective and well-tolerated adjuvant medication for endovascular thrombectomy for patients with large vessel occlusion due to intracranial atherosclerosis. However, the findings needed to be confirmed in future trials.