Tirofiban in Acute Ischemic Stroke patients Undergoing Endovascular Thrombectomy with Preceding intravenous Thrombolysis

Background: The effectiveness of Tirofiban administration to acute ischemic stroke patients undergoing endovascular thrombectomy (EVT) after intravenous thrombolysis (IVT) remains unclear. This study examined the effect of intraarterial or intravenous tirofiban during endovascular thrombectomy following thrombolysis. Methods Patients with acute ischemic stroke who received EVT after thrombolysis were selected from the International Stroke Perfusion Imaging Registry, and divided into three groups according to tirofiban administration. Safety outcomes were symptomatic intracerebral hemorrhage (sICH) and parenchymal hematoma type-2 (PH2). Efficacy outcomes included successful recanalization, complete recanalization, functional independence, and death at 3-months. Univariate and multivariate regression estimates are listed as estimate [95% confidence interval] p-value. Results We analyzed a total of 682 patients who underwent EVT after IVT. Among them, 53 (7.77%) were treated with intraarterial tirofiban (IA-tirofiban group), 80 (11.73%) were treated with intravenous tirofiban (IV-tirofiban group), while 549 (80.50%) patients were not treated with tirofiban (non-tirofiban group). There were no significant differences between groups in the incidences of PH2 or sICH (P=0.413, P=0.256). There were significant differences in successful recanalization, functional independence, and death at 3-months (P=0.031, P<0.001, P=0.010). There was no difference between IA-tirofiban and non-tirofiban in terms of safety or efficacy outcomes. Compared with non-tirofiban, IV-tirofiban was not associated with PH2 (P=0.111; adjusted P=0.705) or sICH (P=0.263; adjusted P=0.168), but was associated with higher odds of successful recanalization (OR=8.94 [1.22-65.53], P=0.031; adjusted OR=8.24 [1.08-62.59], adjusted P=0.041), 3-month functional independence (OR=3.21 [1.88-5.50], P<0.001; adjusted OR=2.22 [1.21-4.12], adjusted P=0.011) and lower odds of 3-month death (OR=0.20 [0.17-0.27], P=0.007; adjusted OR=0.25 [0.07-0.92], adjusted P=0.039). Conclusions In acute ischemic stroke patients undergoing mechanical thrombectomy with preceding intravenous thrombolysis, both intraarterial and intravenous tirofiban could be safe. However, only intravenous tirofiban was associated with clinical benefit. Further randomized clinical trials are needed to confirm these findings. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Dr. Jianhong Yang is supported by the Traditional Chinese Medicine Science and Technology Project of Zhejiang Province (grant no. 2021ZA128)and Ningbo Top Medical and Health Research Program grant no.2022020304. Dr. Gang Li is supported by the Clinical Plateau Discipline Construction Project of Shanghai Pudong New Area Health Committee (grant no. PWYgy2021-05) and the National Natural Science Foundation of China(grant no. 82071192). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The registry had central ethics approval by the Hunter New England Health District ethics committee (reference no: 11/08/17/ 4.01) and institutional ethical approvals. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data in the text is available