Therapeutic Effect Of Tirofiban Given By Intracranial Artery On Acute Ischemic Stroke Beyond Thrombolysis Time Window

Objective:To explore the safety and effectiveness of different dose tirofiban injected through intracranial artery in the treatment of acute ischemic stroke beyond the time window of intravenous thrombolysis.Methods: This study was a retrospective study,which was reviewed by the Ethics Committee of PLA 924 Hospital.A total of 231 patients with acute ischemic stroke who were admitted to PLA 924 Hospital from January 2019 to December 2020 beyond the thrombolytic time window were selected as the study objects.Cranial CT or cranial MRI examination was performed before admission,and cerebral angiography examination was performed in emergency after admission to exclude intracranial large vascular lesions.According to treatment method and the dose of tirofiban varies injecting into the intracranial artery,the 231 patients were divided into the high-dose group(n=77),the low-dose group(n=77)and double antibody group(n=77);they were divided into anterior circulation group and posterior circulation group according to the clinical manifestations of patients and the performance of head MRI or CT.High-dose group: anterior circulation(n=66),posterior circulation(n=11),intracranial arterial infusion of tirofiban 0.5mg at 1ml/min,then intravenous tirofiban 0.3mg / h for 24 hours,6 hours earlier bridging aspirin 100 mg +clopidogrel 75mg;Low-dose group: anterior circulation(n=67),posterior circulation(n=10),intracranial arterial infusion of tirofiban 0.5mg at 1ml/min,then the rest were the same as the high-dose group.In the double antibody group:anterior circulation(n=69),postcirculation(n=8),first dose of double anti-aspirin 300 mg + clopidogrel 300 mg,subsequent conventional aspirin100 mg + clopidogrel 75 mg.Compare and analyze the differences in NIHSS score,m RS score,Fugl-Meyer score,and ADL score before and after treatment between the three groups.Results:(1)Compare general information.There were no significant differences in age,time to admission,and gender composition of the three groups,aand the results has no statistical siginificance(P >0.05).(2)Compare NIHSS scores.There was no statistical difference in NIHSS score before diagnosis and treatment among the three groups(P >0.05).The scores of patients in the three groups decreased after 1 week and 1 month,but NIHSS scores in the high-dose group were significantly lower than those in the low-dose group and the double antibody group,and the low-dose group were significantly lower than the double antibody group,with statistical difference(P<0.05).(3)For m RS score,there was no statistical difference in m RS scores of the three groups before diagnosis and treatment(P >0.05).The m RS scores of patients in the high-dose group at 1 week and 90 days after treatment were lower than those in the low-dose group and the double antibody group,and the low-dose group were significantly lower than the double antibody group,with statistical difference(P <0.05).(4)Compare the Fugl-Meyer score and ADL score.There were no significant differences in Fugl-Meyer score and ADL score among the three groups before treatment(P >0.05).The score data of patients in the three groups increased significantly after 1 month of treatment,but the two scores of patients in the high-dose group were significantly higher than those in the low-dose group and the double antibody group,the low-dose group were significantly higher than the double antibody group,with statistical difference(P <0.05).(5)Comparative incidence of adverse bleeding events: The total incidence of pre-circulation/post-circulation bleeding events in the treatment group(3.03%)/(27.27%)was not significantly different from that in the control group(4.34%)/(25.00%)and the dual control group(4.48%)/(30.00%)(P >0.05).(6)Comparative clinical effect: The total effective rate of the treatment group was 96.97% / 100.00% higher than that of the control group(85.51%)/(87.50%)and the double antibody group(74.63%)/(60.00%),with statistical difference(P <0.05).Conclusion: Intracranial arterial administration of different dose tirofiban in the treatment of acute ischemic stroke patients beyond the time window of intravenous thrombolysis,high-dose tirofiban can effectively prevent platelet aggregation,inhibit thrombosis,make patients restore brain blood circulation as soon as possible,improving the patient’s nerve function,motor abilityand viability.On the other hand,it didn’t increase the risk of adverse events such as cerebral hemorrhage,which is worthy of promotion and application.