Clinical Study Of Arterial Injection Of Tirofiban In The Treatment Of Acute Ischemic Stroke Beyond The Thrombolytic Time Window

Objective: To investigate the clinical efficacy and safety of arterial injection of tirofiban in the treatment of acute ischemic stroke(AIS)patients with onset time between 6h and 24 h without severe stenosis or occlusion of large intracranial or extracranial vessels,with the purpose of providing new treatment guidelines and theoretical basis for AIS patients beyond the thrombolytic time window.Methods: Patients with AIS who were hospitalized in the Department of Neurology of the First Affiliated Hospital of Hainan Medical University from July 2021 to January2023 with an onset time of 6h to 24 h and without severe stenosis or occlusion of large intracranial or extracranial vessels were included in the study.The 126 patients who met the inclusion and exclusion criteria were divided into the tirofiban group(64patients)and the control group(62 patients)according to their treatment intention.In the tirofiban group,tirofiban 0.4-0.5 mg was given via arterial catheter and maintained for 24 h by intravenous pumping at 0.1μg/kg/min postoperatively,with overlapping aspirin enteric-coated tablets 100 mg/d and clopidogrel hydrogen sulfate tablets 4h before discontinuation.75 mg/d double antiplatelet therapy;the control group was given double antiplatelet therapy.The clinical outcomes and prognosis of patients in the two groups were assessed by comparing the National Institutes of Health Stroke Scale(NIHSS)scores before and 24 h,72h and 7d after treatment,the Modified Rankin Scale(m RS)scores before and 90 d after treatment,and the Barthel Index(BI)scores;patients in the tirofiban group were divided into anterior circulation infarct and posterior circulation infarct subgroups according to different infarct sites.Patients in the tirofiban group were divided into anterior circulation infarction and posterior circulation infarction subgroups according to different infarct sites,and the clinical efficacy of tirofiban in different infarct sites was compared.The safety of tirofiban was evaluated by recording any adverse reactions such as bleeding,thrombocytopenia,allergy and death in the two groups within 90 d of treatment.Results: 1.There was no statistically significant difference between the clinical baseline information of patients in the tirofiban and control groups(all P>0.05).2.The differences between the NIHSS scores of the two groups before and 24 h and 72 h after treatment were not statistically significant(all P>0.05);7d after treatment,the differences between the NIHSS scores of the two groups were statistically significant(P<0.05).3.NIHSS scores at 24 h after treatment in the tirofiban group were lower than before treatment,and the difference was statistically significant(P<0.05),while no difference was found in the control group at that time(P>0.05).4.At 7d after treatment,the total effective rate was 90.6% in the tirofiban group and 75.8% in the control group,with statistically significant differences(P<0.05).5.At 7d after treatment,the total effective rate of different infarct sites in the tirofiban group was compared with 92.5%in the anterior circulation infarct group and 87.5% in the posterior circulation infarct group,with no statistically significant difference(P>0.05).6.Before treatment,the differences in m RS scores and BI scores between the two groups were not statistically significant(all P < 0.05);90d after treatment,the m RS scores in the tirofiban group were lower than those in the control group,and the BI scores were higher than those in the control group,and the differences were statistically significant(all P < 0.05).7.At90 d after treatment,the good prognosis rate was 90.6% in the tirofiban group and 72.6%in the control group,with a statistically significant difference(P<0.05).8.At 90 d follow-up,the overall adverse event rate was 12.5% in the tirofiban group and 9.7% in the control group,with no statistically significant difference(P>0.05).Conclusion: 1.Arterial injection of tirofiban can effectively inhibit the progress of stroke and improve the long-term prognosis without increasing the incidence of adverse events in AIS patients who have exceeded the thrombolytic time window and have no severe stenosis or occlusion of large blood vessels inside and outside the brain.2.There is no difference in clinical efficacy of tirofiban in AIS patients with different infarct sites.