Adjunct Intraarterial or Intravenous Tirofiban Versus No Tirofiban After Successful Recanalization of Basilar Artery Occlusion Stroke: The BASILAR Registry

作者全名：Li, Huagang; Ju, Dongsheng; Tao, Zhaojun; Wang, Jiayin; Nguyen, Thanh N.; Saver, Jeffrey L.; Nogueira, Raul G.; Liu, Chang; Yang, Qingwu; Qiu, Zhongming; Yin, Congguo; Sun, Dong; Liu, Shudong

作者地址：[Li, Huagang; Sun, Dong] Wuhan Univ, Zhongnan Hosp, Dept Neurol, Wuhan 430000, Peoples R China; [Ju, Dongsheng] Songyuan Jilin Oilfield Hosp, Dept Neurol, Songyuan, Peoples R China; [Tao, Zhaojun; Wang, Jiayin; Qiu, Zhongming] 903rd Hosp Peoples Liberat Army, Dept Neurol, Hangzhou, Peoples R China; [Nguyen, Thanh N.] Boston Med Ctr, Dept Neurol & Radiol, Boston, MA USA; [Saver, Jeffrey L.] Univ Calif Los Angeles, David Geffen Sch Med, Dept Neurol, Los Angeles, CA USA; [Nogueira, Raul G.] Univ Pittsburgh, UPMC Stroke Inst, Dept Neurol, Sch Med, Pittsburgh, PA USA; [Liu, Chang; Yang, Qingwu; Qiu, Zhongming] Xinqiao Hosp, Dept Neurol, Chongqing, Peoples R China; [Liu, Chang; Yang, Qingwu; Qiu, Zhongming] Third Mil Med Univ, Army Med Univ, Affiliated Hosp 2, Chongqing, Peoples R China; [Yin, Congguo] Zhejiang Univ, Affiliated Hangzhou Peoples Hosp 1, Dept Neurol, Sch Med, Hangzhou, Peoples R China; [Liu, Shudong] Chongqing Med Univ, Dept Neurol, Chongqing Key Lab Cerebrovasc Dis Res, Yongchuan Hosp, Chongqing 402160, Peoples R China

通信作者：Sun, D (通讯作者)，Wuhan Univ, Zhongnan Hosp, Dept Neurol, Wuhan 430000, Peoples R China.; Liu, SD (通讯作者)，Chongqing Med Univ, Dept Neurol, Chongqing Key Lab Cerebrovasc Dis Res, Yongchuan Hosp, Chongqing 402160, Peoples R China.

来源：JOURNAL OF THE AMERICAN HEART ASSOCIATION

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001215553400034

JCR分区：Q1

影响因子：5

年份：2024

卷号：13

期号：5

开始页：　

结束页：　

文献类型：Article

关键词：basilar artery occlusion; endovascular treatment; intra-arterial; prognosis; tirofiban

摘要：BACKGROUND: Approximately half of patients who achieve successful reperfusion do not achieve functional independence. The present study sought to investigate the clinical outcomes and safety of intraarterial or intravenous tirofiban as adjunct therapy in patients with acute basilar artery occlusion who had achieved successful recanalization with endovascular treatment. METHODS AND RESULTS: In the national, prospective BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study) registry, 458 patients who met inclusion criteria were divided into 3 groups based on tirofiban administration (no tirofiban, n=262; intravenous tirofiban, n=101; intraarterial+intravenous tirofiban, n=95). Their clinical outcomes were compared with 90-day modified Rankin Scale scores. Adjusted odds ratios (aORs) and 95% CIs were obtained by logistic regression models and propensity score matching. Safety outcomes included any intracranial hemorrhage (ICH), symptomatic ICH, and mortality. Among 458 included patients, 184 (40.2%) achieved a favorable outcome (modified Rankin Scale score 0-3). There were no differences between the intravenous tirofiban group and the no tirofiban group in terms of safety and clinical outcomes (all P>0.05). Compared with the no tirofiban group, the intraarterial+intravenous tirofiban group had higher odds of 90-day modified Rankin Scale score 0 to 3 (aOR, 2.44 [95% CI, 1.30-4.64], P=0.006) and lower 3-month mortality (aOR, 0.38 [95% CI, 0.19-0.71], P=0.002) without an increase in any ICH (aOR, 0.34 [95% CI, 0.09-1.01], P=0.07) or symptomatic ICH (aOR, 0.23 [95% CI, 0.03-0.90], P=0.05). Similar results of intraarterial+intravenous tirofiban on improving clinical outcomes were detected in novel cohorts constructed by propensity score matching. CONCLUSIONS: Intraarterial+intravenous rather than intravenous tirofiban improved clinical outcomes without increasing the frequency of symptomatic ICH among patients with basilar artery occlusion after successful endovascular treatment. Further studies are needed to delineate the roles of intraarterial+intravenous tirofiban in patients with basilar artery occlusion receiving endovascular treatment.

基金机构：National Natural Science Foundation of China [81901236]

基金资助正文：The study was supported by the National Natural Science Foundation of China (No. 81901236). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the article; and decision to submit the article for publication.