Abstract 418: Targeted tirofiban use for endovascular treatment of ischemic stroke

Purpose For complex thrombus events of intracranial atherosclerotic occlusion, tirofiban, a glycoprotein IIb/IIIa antagonist, could increase the success of endovascular treatment (EVT). This study investigated the applicability of this targeted tirofiban use. Methods Stroke patients undergoing EVT were enrolled with the approval of the prospective use of tirofiban in ongoing thrombosis, re‐occlusion, and in‐stent thrombus formation. The presumptive mechanism of cerebral occlusions was divided into atherosclerotic and other etiologies. Then, the efficacy and safety outcomes of target tirofiban use were evaluated according to the location and mechanism of occlusion. Results Among those with symptomatic intracranial occlusion, 41.8% had atherosclerotic occlusion (ICAO), while 56.2% had atherosclerotic occlusions in the case of extracranial vessels. Tirofiban use rates were 24.5% of ICAO and 20.6% of extracranial atherosclerotic occlusions, while 6.8% of non‐atherosclerotic occlusions. In ICAO, tirofiban use presented a similar successful recanalization rate compared to those who did not use tirofiban (88.9% versus 86.1%), also in symptomatic intracerebral hemorrhage (2.4% versus 1.9%, P=0.81) and stroke recurrence (22.2% versus 13.3%, P=0.11). Multivariate analyses showed that ICAO, with the reference of non‐atherosclerotic occlusion, had no different effect on the successful recanalization (adjusted odds ratio, 0.70; 95% confidence interval, 0.40 ‐ 1.23), stroke recurrence (0.97; 0.55 ‐ 1.65), and SHT (0.51; 0.15 ‐ 1.36) when tirofiban use was taken into consideration. Conclusion Targeted tirofiban use may enhance the chance of recanalization in atherosclerotic occlusion without increasing the risk of safety concerns.