Tirofiban and Endovascular Treatment Versus Endovascular Treatment in Patients with Intracranial Artery Atherosclerosis: A Meta-Analysis of 3,179 Patients.
Amiel Aragon Cortes1, Luis Cueva Cañola2, Dilmareth Natera Rodriguez3, Damaris Velarde1, Erick Calvario4, Yoshua Flores5, Ricardo Orozco1, María Nevárez Rivera6, Diego Pichardo-Rojas7, Veronica Moreno Gomez4
1Universidad Autonoma de Baja California, 2Universidad Nacional de Piura, 3UniverDepartment of Neurosurgery, University of Minnesota, Twin Citiessity of Minnesota, 4University of Utah, 5Instituto Politécnico Nacional, 6Universidad Juárez del Estado de Durango, 7Universidad Atonoma de Baja California
Objective:
We performed a meta-analysis to evaluate the efficacy and safety of tirofiban in patients with LVO-A.
Background:
Endovascular treatment (EVT) is the modality of treatment in select patients with acute ischemic stroke due to large vessel occlusion secondary to atherosclerosis (LVO-A). About 30 % of patients don't achieve successful
reperfusion following endovascular treatment. The adjunctive use of selective glycoprotein IIb/IIIa receptor antagonists, such as Tirofiban, has been shown to improve reperfusion rates following EVT. However, their use in LVO-A is relatively limited.
Design/Methods:
A database search was conducted until July 2024, to identify published studies that compare the use of Tirofiban in LVO-A to a control group. Prophylactic use refers to preventing secondary occlusion. Rescue refers to the use in a patient with unsuccessful reperfusion. The main outcomes assessed included 90-day reocclusion, 90-day mortality, and 90-day favorable modified Rankin Scale (mRS) score (0-2).
Results:
From a total of 1,438 studies, 2 randomized controlled trials and 10 cohorts were included, encompassing a population of 3,179 patients. We found that prophylactic administration of tirofiban significantly reduced the risk of mortality (Risk ratio [RR]=0.65, 95%CI: 0.44-0.95, p=0.03). Both prophylactic and rescue tirofiban administration reduced 90-day mortality (RR=0.74, 95%CI: 0.63-0.87, p=0.002). Rescue Tirofiban was associated with a higher rate of favorable 90-day mRS (RR=2.52, 95%CI: 1.07-5.92, p=0.03) and lower risk of reocclusion (RR=0.58, 95%CI:0.34-0.97, p=0.04) at 90 days.
Conclusions:
Our findings suggest that tirofiban is an effective and safe treatment for improving clinical outcomes in patients with LVO-A. Large multicentric clinical trials are necessary to evaluate the patients that can benefit from the adjunct use of Tirofiban.
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