目的:本研究的目的是探讨术前与术中替罗非班对大动脉粥样硬化(LAA)所致大血管闭塞(LVO)患者的疗效和安全性。
方法:这是一项基于RESCUE-RE(急性缺血性卒中再通后重症监护注册研究)试验的回顾性多中心队列研究,纳入发病24小时内前循环LVO分类为LAA的患者。患者分为三组:术前替罗非班(PT),术中替罗非班(IT),和没有替罗非班(NT)。使用倾向评分匹配(PSM)来平衡基线特征。疗效结果包括90天功能独立性(改良的Rankin量表评分=0-2)和早期部分再通(EPR;定义为改良的脑梗死溶栓评分=1-2a)。安全性结果包括症状性颅内出血(sICH)。
结果:通过PSM总共获得了104个匹配的三胞胎。与NT相比,PT增加了90天的功能独立性(60.8%vs.42.3%,p=0.008)和EPR(42.7%与18.3%,p<0.001)率,有增加无症状颅内出血(aICH)比例的趋势(28.8%vs.18.3%,p=0.072)。与IT相比,PT具有更高的90天功能独立性(60.8%vs.45.2%,p=0.025)和EPR(42.7%与20.2%,p=0.001)率,sICH无显著差异(14.4%vs.7.7%,p=0.122)和aICH(28.8%与21.2%,p=0.200)。与NT相比,IT的90天死亡率较低(9.6%与24.0%,p=0.005)。
结论:替罗非班在LAA引起的急性缺血性卒中-LVO中显示出良好的辅助治疗潜力。PT与更高的EPR发生率和更好的治疗效果相关。此外,EPR可能是改善预后的潜在方法。
OBJECTIVE: The aim of this study is to investigate the efficacy and safety of preoperative versus intraoperative tirofiban in patients with large vessel occlusion (LVO) due to large artery atherosclerosis (LAA).
METHODS: This is a retrospective multicenter cohort study based on the RESCUE-RE (Registration Study for Critical Care of Acute Ischemic Stroke After Recanalization) trial enrolling patients with anterior circulation LVO classified as LAA within 24 h of onset. Patients were divided into three groups: preoperative tirofiban (PT), intraoperative tirofiban (IT), and no tirofiban (NT). Propensity score matching (PSM) was used to balance baseline characteristics. The efficacy outcomes included 90-day functional independence (modified Rankin Scale score = 0-2) and early partial recanalization (EPR; defined as a modified Thrombolysis in Cerebral Infarction score = 1-2a). The safety outcomes included symptomatic intracranial hemorrhage (sICH).
RESULTS: A total of 104 matched triplets were obtained through PSM. Compared with NT, PT increased 90-day functional independence (60.8% vs. 42.3%, p = 0.008) and EPR (42.7% vs. 18.3%, p < 0.001) rate, with a tendency to increase the asymptomatic intracranial hemorrhage (aICH) proportion (28.8% vs. 18.3%, p = 0.072). Compared with IT, PT had a higher 90-day functional independence (60.8% vs. 45.2%, p = 0.025) and EPR (42.7% vs. 20.2%, p = 0.001) rate, with no significant difference in sICH (14.4% vs. 7.7%, p = 0.122) and aICH (28.8% vs. 21.2%, p = 0.200). Compared with NT, IT had a lower 90-day mortality rate (9.6% vs. 24.0%, p = 0.005).
CONCLUSIONS: Tirofiban shows good adjuvant therapy potential in acute ischemic stroke-LVO due to LAA patients. PT is associated with higher rates of EPR and better therapeutic efficacy. In addition, EPR may be a potential way to improve prognosis.