The Clinical Efficacy And Safety Of Perioperative Application Of Tirofiban During Mechanical Thrombectomy For Acute Ischemic Stroke

Objective:Acute ischemic stroke(AIS) is a neurological deficit syndrome caused by various blood circulation disorders in the brain.In recent years,the incidence of stroke in China has increased year by year.Because of its high mortality and disability rate,AIS has become the number one factor threatening the health of the elderly in China.The key to AIS therapy is to recanalize the occlusion artery at the early stage of the onset,restore blood flow and save ischemic and hypoxic brain cells.At present,rt-PA(recombinant tissue plasminogen activator)intravenous thrombolysis within4.5 hours of onset has been recognized as the most effective early vascular recanalization method.However,due to the time window limitation and poor efficacy for large vessel occlusion,the number of beneficiaries is still limited.Since the 21 st century,intravascular mechanical thrombectomy have been well developed with the introduction of advanced thrombectomy devices and the improvement of surgical methods,more and more AIS patients have benefited from surgery rather than medical treatment.International multi-center randomized controlled clinical trials have confirmed the safety and efficacy of mechanical thrombectomy.The operation time window has been extended to 24 h and the scope of surgery has also been extended to posterior circulation stroke by latest studies.Platelet glycoprotein IIa / Ⅲb receptor antagonist tirofiban,as a powerful intravenous antiplatelet drug,has been widely used in intravascular treatment for acute myocardial infarction.Our study aims to investigate the safety of perioperative application of tirofiban during mechanical thrombectomy in AIS and its impact on functional outcomes by analyzing the risk factor of postoperative symptomatic intracranial hemorrhage(s ICH)and poor functional prognosis that could provide help for individualized treatment plan for thrombectomy.Methods:From October 2016 to September 2019,AIS patients who underwent arterial mechanical thrombectomy in the Department of Neurology of the Shanghai Ninth People’s Hospital were selected according to the entry criteria.On the basis of whether perioperative intravenous tirofiban was used,patients were divided into tirofiban group and non-tirofiban group.The NIHSS scores before and 7 days after operation,clinical treatment plan and hemorrhagic transformation were collected.Patients were followed up for 90 days with m RS score.Then,we compared the differences in clinical treatment options,subtypes of hemorrhagic transformation,and functional outcomes between the two groups and analyzed the risk factors for s ICH and poor functional outcomes by multi-factor logistic regression.Results:A total of 84 patients with mechanical ischemic thrombectomy who met the entry criteria were selected,including 35 patients in tirofiban group(41.7%)and 49 patients in non-tirofiban group(58.3%).The proportion of intravenous thrombolysis before thrombectomy in tirofiban group was lower than that of non-tirofiban group,and the difference was statistically significant(P = 0.003).There was no statistically significant difference in clinical prognostic indicators between the two groups in terms of hemorrhagic transformation,s ICH,mortality and favorable functional outcome(P> 0.05).Through multivariate logistic regression analysis,it was found that perioperative intravenous tirofiban was not a risk factor for postoperative s ICH and unfavorable functional outcome.In addition,the study found that long-term oral anticoagulation drugs usage before surgery is an independent risk factor for s ICH after thrombectomy(P= 0.003);in the90-day follow-up,higher pre-operative NIHSS score and advanced age are independent predictor of unfavorable outcome.Conclusion:In patients with AIS caused by large arteries occlusion,tirofiban does not significantly increase the risk of postoperative s ICH,indicating that intravenous use of tirofiban during perioperative period of mechanical thrombectomy may be safe.However,long-term oral anticoagulant drugs usage before surgery increased the risk of postoperative s ICH which should be fully paid attention to in clinical practice.Furthermore,higher NIHSS score and advanced age are independent predictors of unfavorable functional outcomes.In conclusion,the effect of tirofiban on the long-term functional outcome of patients need further research and exploration.