Abstract Body: Background: The effectiveness and safety of intravenous Tirofiban as an adjunct to endovascular therapy (EVT) in posterior circulation patients with tandem lesions (PCTL) remain uncertain.
Methods: This study utilized individual patient data pooled from two multicenter observational studies: the BASILAR and the PERSIST registries. We included patients with acute ischemic stroke due to PCTLs who were treated with EVT. The patients were divided into two groups based on whether they received adjunctive intravenous Tirofiban therapy or not. The primary efficacy outcome was favorable functional outcome, defined as modified Rankin Scale (mRS) scores of 0-3 at one year. Secondary outcomes included safety assessments, such as rates of symptomatic intracerebral hemorrhage (sICH), early neurological deterioration (defined as a decline in National Institutes of Health Stroke Scale [NIHSS] score by ≥4 points within 72h), and all-cause mortality at one year. We also evaluated procedural outcomes, including successful reperfusion, defined as modified Thrombolysis in Cerebral Infarction (mTICI) grade 2b-3, and complete reperfusion, defined as mTICI 3.
Results: Among 210 patients treated with EVT (126 Tirofiban, 84 Non-Tirofiban), successful reperfusion (mTICI 2b-3) was achieved in 109 (86.5%) Tirofiban patients versus 64 (76.2%) non-Tirofiban patients (Adjusted OR 1.75, 95%CI [0.76-4.03], P=0.19). Complete reperfusion (mTICI 3) was achieved in 74 (58.7%) Tirofiban patients versus 36 (42.9%) non-Tirofiban patients (Adjusted OR 2.08, 95%CI [1.04-4.14], P=0.04). Rates of sICH were 6 (4.8%) in the Tirofiban group versus 9 (10.7%) in the non-Tirofiban group (Adjusted OR 0.24, 95%CI [0.04-1.36], P=0.11). Early neurological deterioration occurred in 18 (14.3%) Tirofiban patients versus 32 (38.1%) non-Tirofiban patients (Adjusted OR 0.20, 95%CI [0.09-0.46], P<0.001). One-year mRS 0-3 was achieved in 48/119 (40.3%) Tirofiban patients versus 24/82 (29.3%) non-Tirofiban patients (Adjusted OR 5.38, 95%CI [2.21-13.06], P<0.001). One-year mortality was 45/119 (37.8%) in the Tirofiban group versus 43/82 (52.4%) in the non-Tirofiban group (Adjusted OR 0.26, 95%CI [0.12-0.59], P=0.001).
Conclusion: Intravenous Tirofiban as an adjunct to EVT may improve long-term functional outcomes in acute ischemic stroke patients due to PCTLs without significantly increasing the risk of hemorrhagic complications. Further prospective studies are warranted to validate these findings.