Efficacy and safety analysis of tirofiban application during endovascular treatment of acute ischemic stroke with large artery atherosclerosis

MA Wen-long; HAN Xiang-ning; LI Jia-hao; CHENG Ya-wen; HAN Jian-feng; LIU Fu-de

doi:10.3969/j.issn.1672-6731.2025.09.011

Abstract：Objective To investigate the efficacy and safety of tirofiban application during emergency endovascular treatment in patients with acute ischemic stroke due to large artery atherosclerosis(LAA).Methods A total of 326 patients diagnosed with acute ischemic stroke due to LAA and subjected to emergency endovascular treatment at The First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to June 2023 were enrolled.All patients underwent endovascular treatment and were divided into tirofiban group(n=183)and non-tirofiban group(n=143)based on intraoperative tirofiban application.The primary outcome was defined as the modified Rankin Scale(mRS)score of 0-2(functional independence)at 90 d postoperatively.Secondary outcomes were included mRS score of 0-1(excellent prognosis)at 90 d,the mRS score of 0-3(favorable prognosis)at 90 d,and modified Thrombolysis in Cerebral Infarction(mTICI)≥2b(successful recanalization).Security indicators were included the incidence of symptomatic intracranial hemorrhage(sICH)within 24 h postoperatively,the incidence of intracranial hemorrhage(ICH)within 24 h postoperatively,and the all-cause mortality at 90 d postoperatively.Results Regarding the primary outcome,no statistically significant difference was observed between the 2 groups in the proportion of patients achieving the mRS score of 0-2 at 90 d postoperatively(χ2=0.703,P=0.402).For secondary outcomes,there were no significant differences between the 2 groups in the following measures:mRS score of 0-1 at 90 d postoperatively(χ2=0.359,P=0.549),mRS score of 0-3 at 90 d postoperatively(χ2=2.513,P=0.113),mTICI≥2b postoperatively(χ2=0.763,P=0.384).In terms of security indicators,no statistically significant differences were observed between the 2 groups in the following:incidence of sICH(χ2=0.257,P=0.612),incidence of ICH(χ2=3.561,P=0.059)at 24 h postperatively,all-cause mortality at 90 d postoperatively(χ2=0.370,P=0.543).Logistic regression analysis showed that intraoperative tirofiban application was not an independent predictor of functional independence(mRS score of 0-2)at 90 d postoperatively.Conclusions In patients with acute ischemic stroke due to LAA,the tirofiban application during emergency endovascular treatment did not significantly improve clinical outcomes.However,it was not associated with an increased risk of ICH or mortality.