Safety and Efficacy of Intracranial Stenting in Acute Stroke Patients Using a Pharmacological Treatment Protocol Including Low-Dose Intra-arterial Eptifibatide-A Single-center Retrospective Analysis.

Abstract

Purpose: Emergent intracranial stenting (EICS) has demonstrated efficacy in managing intracranial stenosis in patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke. However, an optimal pharmacological regimen balancing thrombosis prevention and hemorrhagic risk following stent deployment remains undefined. This study aimed to assess the safety and efficacy of prophylactic low-dose intra-arterial Eptifibatide following EICS.

Methods: This single-center retrospective study included 57 consecutive patients who underwent EICS following MT due to an underlying intracranial stenosis. Patients received intravenous heparin and Aspirin pre-stenting, followed by prophylactic low-dose intra-arterial Eptifibatide post-stenting. Univariate and multivariable logistic regression analyses were conducted to identify factors associated with 90-day functional outcomes, categorized as favorable (modified Rankin Scale [mRS] 0-2) and non-favorable (mRS 3-6).

Results: Among 57 patients who underwent EICS, 93.0% (n = 53) received a balloon-mounted coronary stent. Successful recanalization (TICI 2b/3) was achieved in 93.0% of cases. Intracranial hemorrhage was detected in 8.8% within 24 h post-procedure. The median mRS score at 90 days was 3.5 (IQR 1-6), with 40.4% of patients achieving favorable functional outcomes (mRS 0-2). Advanced age was independently associated with a non-favorable functional prognosis (OR = 1.06, 95% CI: 1.00-1.11, P = 0.034).

Conclusions: In cases of MT requiring EICS, the administration of low-dose intra-arterial Eptifibatide immediately post-stenting, in addition to post-procedure dual anti-platelet therapy, demonstrated high recanalization rates with a favorable safety profile.