Association of Intravenous Tirofiban with Functional Outcomes in Acute Ischemic Stroke Patients with Acute Basilar Artery Occlusion Receiving Endovascular Thrombectomy.
Association of Intravenous Tirofiban with Functional Outcomes in Acute Ischemic Stroke Patients with Acute Basilar Artery Occlusion Receiving Endovascular Thrombectomy.
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DOI：
10.1159/000527483
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发表时间：
2023
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这项研究的目的是验证这样一种假设，即静脉注射替罗非班在不增加因基底动脉闭塞(BAO)接受血管内血栓摘除术而继发于卒中的颅内出血(ICH)风险的情况下，改善功能结果。接受血管内血栓摘除术治疗并获得替罗非班治疗信息的急性Bao卒中患者来自“Basilar”：一项全国性的前瞻性登记。所有符合条件的患者根据是否静脉使用替罗非班分为替罗非班组和非替罗非班组。主要终点是90天的残疾严重程度，通过修改的Rankin量表评分进行评估。安全性结果是脑出血的频率和死亡率。在这个队列中的645名患者中，替罗非班组有363名患者，非替罗非班组有282名患者。血栓切除联合静脉注射替罗非班降低了90天的残疾水平，超过了修正的Rankin量表的范围(调整后的共同优势比，2.08；95%可信区间，1.452.97；p<；0.001)。替罗非班组患者的90天死亡率低于非替罗非班组(41.6%比52.1%；调整后的危险比为0.6；95%的可信区间为0.47-0.77；p<；0.001)。替罗非班组的脑出血发生率(6.7%比13.7%；p=0.004)和症状性脑出血(4.8%比10.1%；p=0.01)明显低于非替罗非班组。在接受血管内治疗的急性BO卒中患者中，静脉注射替罗非班可能与良好的预后、降低死亡率和减少脑出血频率有关。
The aim of this study was to test the hypothesis that intravenous tirofiban improves functional outcomes without promoting the risk of intracranial hemorrhage (ICH) in stroke secondary to basilar artery occlusion (BAO) receiving endovascular thrombectomy. Patients with acute BAO stroke who were treated with endovascular thrombectomy and had tirofiban treatment information were derived from “BASILAR”: a nationwide, prospective registry. All eligible patients were divided into tirofiban and no-tirofiban groups according to whether tirofiban was used intravenously. The primary endpoint was the 90-day severity of disability as assessed by the modified Rankin scale score. Safety outcomes were the frequency of ICH and mortality. Of 645 patients included in this cohort, 363 were in the tirofiban group and 282 were in the no-tirofiban group. Thrombectomy with intravenous tirofiban reduced the 90-day disability level over the range of the modified Rankin scale (adjusted common odds ratio, 2.08; 95% confidence interval (CI), 1.45–2.97; p < 0.001). The 90-day mortality of patients in the tirofiban group was lower than that in the no-tirofiban group (41.6% vs. 52.1%; adjusted hazard ratio, 0.60; 95% CI, 0.47–0.77; p < 0.001). The frequency of any ICH (6.7% vs. 13.7%; p = 0.004) and symptomatic ICH (4.8% vs. 10.1%; p = 0.01) in the tirofiban group was significantly lower than that in the no-tirofiban group. In patients with acute BAO stroke who underwent endovascular treatment, intravenous tirofiban might be associated with favorable outcome, reduced mortality, and a decreased frequency of ICH.
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