Clinical Research
The safety and efficacy of tirofiban on prevention of vascular reocclusion following mechanical thrombectomy for in situ thrombosis
Dai Zheng, Li Min, Wang Huaiming, Dai Qiliang, Xu Jian, Liu Xinfeng
Published 2017-06-08
Cite as Chin J Neurol, 2017, 50(6): 440-444. DOI: 10.3760/cma.j.issn.1006-7876.2017.06.008
Abstract
ObjectiveTo evaluate the safety and efficacy of low-dose platelet glycoprotein Ⅱb/Ⅲa antagonist tirofiban on preventing reocclusion during mechanical thrombectomy (MT) for in situ thrombosis(IST).
MethodsIt is a retrospective cohort study, and 112 patients treated with MT, from the Nanjing Prospective Stroke Registration, were enrolled from February 2014 to October 2014. During MT, if angiography after a successful recanalization(defined as Thrombolysis In Cerebral Infarction(TICI) 2b/3) showed residual stenosis at the site of occlusion, additional angiographies were made every 10 min for 30 min. Then, if angiography displayed reocclusion in the corresponding vessels, a repeat recanalization was operated, followed by a low dose intra-arterial tirofiban infusion. MRA or CT angiography (CTA) was implemented to identify intracranial atherosclerosis (ICAS) 5-7 days after the procedure. The patients with confirmed ICAS were enrolled in the IST group. The rest were enrolled in the non-in situ thrombosis (NIST) group.
ResultsA total of 80 patients with acute cerebral infarction were enrolled in the study. IST rate was 32.5%(26/80). All IST patients were confirmed ICAS by follow-up vascular imaging. Instant reocclusion after successful recanalization was significantly more common in the IST group(57.7%(15/26) vs 3.7%(2/54); χ 2=30.568, P=0.000) than in the NIST group. In the case of the efficacy and safety of low-dose intra-arterial tirofiban infusion, 82.6%(19/23) of the reocclusion patients eventually accomplished TICI 2b/3, the rest 17.4%(4/23) of the cases were intractable to the procedure and needed rescue stent implantation. The modified Rankin Scale scores in patients infusing tirofiban were superior to the unused patients in 90 days. There was no patient with symptomatic intracranial hemorrhage after the procedure.
ConclusionsPatients with IST have higher cerebrovascular reocclusion rate during MT. After MT, low-dose intra-arterial tirofiban infusion may prevent reocclusion, and the prognosis is better.
Key words:
Stroke; Platelet membrane glycoproteins; Thrombosis; Thrombectomy
Contributor Information
Dai Zheng
Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
Li Min
Wang Huaiming
Dai Qiliang
Xu Jian
Liu Xinfeng
