Tirofiban versus aspirin to prevent in-stent thrombosis after emergent carotid artery stenting in acute ischemic stroke.

IF 4.5 1区 医学 Q1 NEUROIMAGING
Manuel Medina-Rodriguez, Diego Villagran, Antonio Cristobal Luque-Ambrosiani, Juan Antonio Cabezas-Rodríguez, Leire Ainz-Gómez, Pablo Baena Palomino, Blanca Pardo-Galiana, Aynara Zamora, Asier de Albóniga-Chindurza, Marta Aguilar-Perez, Alejandro González, Francisco Moniche, Elena Zapata-Arriaza
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引用次数: 0

Abstract

Background: Several antithrombotic treatments during emergent carotid artery stenting (eCAS) have been proposed, but an appropriate protocol to balance risk-benefit is not well known.

Objective: To investigate the efficacy and safety of tirofiban compared with aspirin in patients with acute ischemic stroke undergoing eCAS.

Methods: We conducted a retrospective single-center study of the prospective ARTISTA Registry, including patients with atherosclerotic internal carotid artery occlusion treated with eCAS. Two groups, according to antiplatelet drug, were studied: aspirin (250-500 mg single-dose) versus tirofiban (500 μg bolus+200 μg/h). Primary outcomes were the rate of in-stent thrombosis and symptomatic intracranial hemorrhage (sICH) within the first 24 hours.

Results: During the period 2019-2023, 181 patients were included, 103 received aspirin, 78 tirofiban; 149 (82.3%) had tandem lesions. The primary efficacy outcome occurred in 9 (9.4%) in the aspirin group, as compared with 1 (1.3%) in the tirofiban group (adjusted odds ratio (aOR)=0.11, 95% CI 0.01 to 0.98; P=0.048). The primary safety outcome was detected in 12 (11.7%) in the aspirin group, as compared with 2 (2.6%) in the tirofiban group (aOR=0.16, 95% CI 0.03 to 0.87; P=0.034). The tirofiban group presented a lower risk of parenchymal hemorrhage (18 (17.4%) vs 4 (5.2%), aOR=0.27, 95% CI 0.09 to 0.88; P=0.029) and an increased rate of excellent recanalization (expanded Treatment in Cerebral Infarction (eTICI) 2c-3) (50 (48.5%) vs 54 (69.2%); aOR=2.15, 95% CI 1.12 to 4.13; P=0.02). There were no differences in functional outcomes or mortality at 3 months.

Conclusions: Periprocedural antithrombotic therapy with tirofiban was associated with a lower risk of in-stent thrombosis and sICH at 24 hours from eCAS compared with aspirin. Prospective randomized clinical trials are needed to confirm our results.

在急性缺血性脑卒中急诊颈动脉支架置入术后,替罗非班与阿司匹林相比可预防支架内血栓形成。
背景:在急诊颈动脉支架置入术(eCAS)期间,有多种抗血栓治疗方法被提出,但平衡风险与收益的适当方案尚不十分清楚:目的:研究在接受 eCAS 的急性缺血性卒中患者中,与阿司匹林相比,替罗非班的有效性和安全性:我们对前瞻性 ARTISTA 注册中心进行了一项回顾性单中心研究,其中包括接受 eCAS 治疗的动脉粥样硬化性颈内动脉闭塞患者。研究根据抗血小板药物分为两组:阿司匹林(250-500 毫克单剂量)与替罗非班(500 微克栓剂+200 微克/小时)。主要结果为支架内血栓形成率和最初24小时内症状性颅内出血(sICH)率:2019-2023年间,共纳入181例患者,其中103例接受阿司匹林治疗,78例接受替罗非班治疗;149例(82.3%)为串联病变。阿司匹林组有9例(9.4%)出现主要疗效结果,而替罗非班组只有1例(1.3%)(调整后赔率比(aOR)=0.11,95% CI 0.01至0.98;P=0.048)。阿司匹林组有12人(11.7%)出现主要安全性结果,而替罗非班组只有2人(2.6%)(aOR=0.16,95% CI 0.03至0.87;P=0.034)。替罗非班组发生脑实质出血的风险较低(18 (17.4%) vs 4 (5.2%),aOR=0.27,95% CI 0.09 to 0.88;P=0.029),极佳再通畅率(脑梗死扩大治疗(eTICI)2c-3)较高(50 (48.5%) vs 54 (69.2%);aOR=2.15,95% CI 1.12 to 4.13;P=0.02)。3个月后的功能预后或死亡率无差异:结论:与阿司匹林相比,使用替罗非班进行围手术期抗血栓治疗与较低的支架内血栓形成风险和eCAS 24小时后的sICH相关。需要进行前瞻性随机临床试验来证实我们的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.50
自引率
14.60%
发文量
291
审稿时长
4-8 weeks
期刊介绍: The Journal of NeuroInterventional Surgery (JNIS) is a leading peer review journal for scientific research and literature pertaining to the field of neurointerventional surgery. The journal launch follows growing professional interest in neurointerventional techniques for the treatment of a range of neurological and vascular problems including stroke, aneurysms, brain tumors, and spinal compression.The journal is owned by SNIS and is also the official journal of the Interventional Chapter of the Australian and New Zealand Society of Neuroradiology (ANZSNR), the Canadian Interventional Neuro Group, the Hong Kong Neurological Society (HKNS) and the Neuroradiological Society of Taiwan.
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