Local Tirofiban Infusion for Remnant Stenosis in Large Vessel Occlusion: Tirofiban ASSIST study

Abstract Background Compared to embolic occlusions, intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusions (LVOs) often require rescue treatment following mechanical thrombectomy (MT). Herein, we hypothesized that local tirofiban infusion can be effective and safe for remnant stenosis in LVO during endovascular treatment, and can improve clinical outcomes. Methods This observational multicenter registry study (January 2011 to February 2016) included patients with ICAS who underwent endovascular treatment for LVO within 24 hours after stroke onset. An underlying fixed focal stenosis at the occlusion site observed on a cerebral angiography during and after MT was retrospectively determined as a surrogate marker of ICAS. Procedural and clinical outcomes were compared between the tirofiban and non-tirofiban groups. Results Patients were older (median, 71 years vs. 63 years, p = 0.015) and the onset to puncture time was longer (median, 395 min vs. 275 min, p = 0.036) in the tirofiban group than in the non-tirofiban group. Final reperfusion success (modified Treatment In Cerebral Ischemic 2b–3) was more frequent (86.4% vs. 42.4%, p = 0.016) and post-procedure parenchymal hematoma type 2 and/or thick subarachnoid hemorrhages were less frequent (5.1% vs. 15.3%, p = 0.068) in the tirofiban group. The frequency of favorable outcomes 3 months after endovascular revascularization therapy (modified Rankin Scale 0–2) was significantly higher in the tirofiban group (52.5% vs. 32.2%, p = 0.025) and tirofiban administration was an independent predictor of favorable outcomes (odds ratio, 4.013; 95% confidence interval, 1.300–12.386; p = 0.016). Conclusions Local tirofiban infusion may be an effective and safe adjuvant treatment option for patients with ICAS-LVO.