ABSTRACT NUMBER: ESOC2026A2287 EARLY DUPLEX SONOGRAPHIC STENO-OCCLUSION AFTER ENDOVASCULAR TREATMENT OF MCA OCCLUSION AND PERIPROCEDURAL TIROFIBAN

Abstract Background and aims Early re-stenosis or re-occlusion after endovascular therapy (EVT) for middle cerebral artery (MCA) occlusion in intracranial atherosclerotic disease worsens outcomes. We investigated the association between periprocedural tirofiban and post-interventional steno-occlusion assessed by transcranial duplex sonography. Methods We retrospectively analyzed patients with proximal MCA occlusion due to angiographically-confirmed intracranial stenosis treated at a tertiary stroke center (10/2018-11/2025). EVT was performed with or without intracranial stenting; tirofiban was administered at the treating interventionalist’s discretion. Transcranial color-coded duplex sonography (TCCS) was performed within 48 hours after final angiographic run. Post-interventional stenosis was classified as no/moderate and severe/occlusive. Post-interventional intracerebral hemorrhage (ICH, defined as PH1/PH2) was assessed within 24 hours; favorable functional outcome at 3 months was defined as mRS 0-2. Results Of 75 patients, 27 were excluded due to insufficient acoustic windows, leaving 48 patients for analysis; 29 (60.4%) received tirofiban. Intracranial stenting was performed in 36 patients (75%). Post-interventional stenosis or occlusion occurred in 32 patients (66.7%). Tirofiban was not associated with reduced odds of severe post-interventional stenosis or occlusion in the overall cohort (aOR 0.86, 95%CI 0.24–3.05; p=0.82) or in stented patients (aOR 0.63, 95%CI 0.12–3.22; p=0.57). Post-interventional ICH occurred in 17.9% with tirofiban and 0% without (p=0.072). Favorable outcome at 90 days was observed in 22.2% with tirofiban and 44.4% without (p=0.188). Conclusions TCCS-detected steno-occlusion after EVT for MCA occlusion was common. Periprocedural tirofiban was not associated with reduced steno-occlusion, hemorrhage risk or favorable functional outcome. Conflict of interest Daniela Schöne: nothing to disclose, Jan Emmerich: nothing to disclose, Daniel P. Kaiser: nothing to disclose, Volker Puetz: nothing to disclose, Timo Siepmann: nothing to disclose, Johannes Gerber: nothing to disclose, Hagen B. Huttner: nothing to disclose, Kristian Barlinn: nothing to disclose