Effect of Intravenous Tirofiban Versus Placebo on First‐Pass Successful Reperfusion in Endovascular Stroke Thrombectomy: Insights From the RESCUE BT Randomized Clinical Trial
Background First‐pass successful reperfusion (FPSR), defined as a successful/complete reperfusion achieved after a single thrombectomy pass, is predictive of favorable outcome in patients with acute ischemic stroke with large‐vessel occlusion. It is unknown whether intravenous tirofiban is effective...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-11-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.036350 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846149916624158720 |
|---|---|
| author | Junjie Yuan Hanming Ge Zhaojun Tao Huijie An Qin Han Jeffrey L. Saver Thanh N. Nguyen Simin Zhou An Mao Yuelu Wu Raul Gomes Nogueira Yaxuan Sun Shunfu Jiang Liping Wei Xinmin Fu Yongjie Bai Shunyu Yang Wei Hu Guling Zhang Chengde Pan Shuai Zhang Lin Qiao Qiong Chen Hongfei Sang Zhongming Qiu Fengfu Wu Mingze Chang Zhongfan Ruan |
| author_facet | Junjie Yuan Hanming Ge Zhaojun Tao Huijie An Qin Han Jeffrey L. Saver Thanh N. Nguyen Simin Zhou An Mao Yuelu Wu Raul Gomes Nogueira Yaxuan Sun Shunfu Jiang Liping Wei Xinmin Fu Yongjie Bai Shunyu Yang Wei Hu Guling Zhang Chengde Pan Shuai Zhang Lin Qiao Qiong Chen Hongfei Sang Zhongming Qiu Fengfu Wu Mingze Chang Zhongfan Ruan |
| author_sort | Junjie Yuan |
| collection | DOAJ |
| description | Background First‐pass successful reperfusion (FPSR), defined as a successful/complete reperfusion achieved after a single thrombectomy pass, is predictive of favorable outcome in patients with acute ischemic stroke with large‐vessel occlusion. It is unknown whether intravenous tirofiban is effective in increasing the rate of FPSR in acute anterior large‐vessel occlusion stroke. Methods and Results Patients who had acute large‐vessel occlusion stroke presenting within 24 hours and underwent endovascular thrombectomy were analyzed from the RESCUE BT (Intravenous Tirofiban for Patients With Large Vessel Occlusion Stroke) clinical trial, of which the main analysis was neutral. The RESCUE BT trial randomized patients to receive either intravenous tirofiban or placebo before endovascular thrombectomy. The primary end point was FPSR, defined as successful reperfusion (extended thrombolysis in cerebral infarction scale 2b50, 2c, or 3) at first thrombectomy attempt. A modified Poisson regression analysis assessed the association between intravenous tirofiban treatment and FPSR. Of 948 enrolled patients, 463 patients were randomized to the tirofiban group and 485 to the placebo group. The mean age was 67 years, and 41.0% of the patients were women. FPSR was achieved more often in the tirofiban group (30.5% versus 23.5%; adjusted risk ratio, 1.24 [95% CI, 1.01–1.51]; P=0.04). FPSR was associated with a favorable shift to lower modified Rankin Scale disability levels at 90 days (common odds ratio, 1.42 [95% CI, 1.08–1.86]; P=0.01). Conclusions In this post hoc analysis of the RESCUE BT trial, treatment with intravenous tirofiban before endovascular thrombectomy was associated with increased FPSR in patients with acute ischemic stroke due to large‐vessel occlusion in the anterior circulation. FPSR was associated with reduced 90‐day levels of disability. Registration URL: http://chictr.org; Unique Identifier: ChiCTR‐INR‐17014167. |
| format | Article |
| id | doaj-art-c9f1a1a941724682ad72c40f67abb3a0 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-c9f1a1a941724682ad72c40f67abb3a02024-11-29T09:50:51ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-11-01132110.1161/JAHA.124.036350Effect of Intravenous Tirofiban Versus Placebo on First‐Pass Successful Reperfusion in Endovascular Stroke Thrombectomy: Insights From the RESCUE BT Randomized Clinical TrialJunjie Yuan0Hanming Ge1Zhaojun Tao2Huijie An3Qin Han4Jeffrey L. Saver5Thanh N. Nguyen6Simin Zhou7An Mao8Yuelu Wu9Raul Gomes Nogueira10Yaxuan Sun11Shunfu Jiang12Liping Wei13Xinmin Fu14Yongjie Bai15Shunyu Yang16Wei Hu17Guling Zhang18Chengde Pan19Shuai Zhang20Lin Qiao21Qiong Chen22Hongfei Sang23Zhongming Qiu24Fengfu Wu25Mingze Chang26Zhongfan Ruan27Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital Army Medical University (Third Military Medical University) Chongqing ChinaDepartment of Neurology, Xi’an No. 3 Hospital The Affiliated Hospital of Northwest University Xi’an ChinaDepartment of Medical Engineering The 903rd Hospital of The People’s Liberation Army Hangzhou ChinaDepartment of Pharmacy General Hospital of Southern Theatre Command, PLA Guangzhou ChinaDepartment of Neurology The 903rd Hospital of The People’s Liberation Army Hangzhou ChinaDepartment of Neurology David Geffen School of Medicine at UCLA Los Angeles CA USADepartment of Neurology and Radiology Boston Medical Center Boston MA USADepartment of Neurology The 903rd Hospital of The People’s Liberation Army Hangzhou ChinaDepartment of Neurology The 903rd Hospital of The People’s Liberation Army Hangzhou ChinaDepartment of Neurology The 903rd Hospital of The People’s Liberation Army Hangzhou ChinaUPMC Stroke Institute, Department of Neurology and Neurosurgery University of Pittsburgh School of Medicine Pittsburgh PA USADepartment of Neurology Shanxi Provincial People’s Hospital Taiyuan ChinaDepartment of Neurology Jingdezhen First People’s Hospital Jingdezhen ChinaDepartment of Neurology Luoyang Central Hospital Luoyang ChinaDepartment of Neurology Xuzhou Central Hospital Xuzhou ChinaDepartment of Neurology The First Affiliated Hospital of Henan Science and Technology University Luoyang ChinaDepartment of Neurology The First People’s Hospital of Yunnan Province Kunming ChinaDepartment of Neurology The First Affiliated Hospital of University of Science and Technology of China Hefei ChinaDepartment of Neurology Danzhai County People’s Hospital Qiandongnan ChinaDepartment of Neurology Banan District People’s Hospital Chongqing ChinaDepartment of Neurology The Affiliated Hospital of Yangzhou University Yangzhou ChinaDepartment of Anesthesiology Xi’an No. 5 Hospital Xi’an ChinaDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital Army Medical University (Third Military Medical University) Chongqing ChinaDepartment of Neurology, Affiliated Hangzhou First People’s Hospital Zhejiang University School of Medicine Hangzhou ChinaDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital Army Medical University (Third Military Medical University) Chongqing ChinaDepartment of Neurology The 925th Hospital of The Chinese People’s Liberation Army Guiyang ChinaDepartment of Neurology, Xi’an No. 3 Hospital The Affiliated Hospital of Northwest University Xi’an ChinaDepartment of Neurology, The First Affiliated Hospital, Hengyang Medical School University of South China Hengyang ChinaBackground First‐pass successful reperfusion (FPSR), defined as a successful/complete reperfusion achieved after a single thrombectomy pass, is predictive of favorable outcome in patients with acute ischemic stroke with large‐vessel occlusion. It is unknown whether intravenous tirofiban is effective in increasing the rate of FPSR in acute anterior large‐vessel occlusion stroke. Methods and Results Patients who had acute large‐vessel occlusion stroke presenting within 24 hours and underwent endovascular thrombectomy were analyzed from the RESCUE BT (Intravenous Tirofiban for Patients With Large Vessel Occlusion Stroke) clinical trial, of which the main analysis was neutral. The RESCUE BT trial randomized patients to receive either intravenous tirofiban or placebo before endovascular thrombectomy. The primary end point was FPSR, defined as successful reperfusion (extended thrombolysis in cerebral infarction scale 2b50, 2c, or 3) at first thrombectomy attempt. A modified Poisson regression analysis assessed the association between intravenous tirofiban treatment and FPSR. Of 948 enrolled patients, 463 patients were randomized to the tirofiban group and 485 to the placebo group. The mean age was 67 years, and 41.0% of the patients were women. FPSR was achieved more often in the tirofiban group (30.5% versus 23.5%; adjusted risk ratio, 1.24 [95% CI, 1.01–1.51]; P=0.04). FPSR was associated with a favorable shift to lower modified Rankin Scale disability levels at 90 days (common odds ratio, 1.42 [95% CI, 1.08–1.86]; P=0.01). Conclusions In this post hoc analysis of the RESCUE BT trial, treatment with intravenous tirofiban before endovascular thrombectomy was associated with increased FPSR in patients with acute ischemic stroke due to large‐vessel occlusion in the anterior circulation. FPSR was associated with reduced 90‐day levels of disability. Registration URL: http://chictr.org; Unique Identifier: ChiCTR‐INR‐17014167.https://www.ahajournals.org/doi/10.1161/JAHA.124.036350acute ischemic strokeanterior large‐vessel occlusionendovascular therapyfirst‐pass successful reperfusionintravenous tirofiban |
| spellingShingle | Junjie Yuan Hanming Ge Zhaojun Tao Huijie An Qin Han Jeffrey L. Saver Thanh N. Nguyen Simin Zhou An Mao Yuelu Wu Raul Gomes Nogueira Yaxuan Sun Shunfu Jiang Liping Wei Xinmin Fu Yongjie Bai Shunyu Yang Wei Hu Guling Zhang Chengde Pan Shuai Zhang Lin Qiao Qiong Chen Hongfei Sang Zhongming Qiu Fengfu Wu Mingze Chang Zhongfan Ruan Effect of Intravenous Tirofiban Versus Placebo on First‐Pass Successful Reperfusion in Endovascular Stroke Thrombectomy: Insights From the RESCUE BT Randomized Clinical Trial Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute ischemic stroke anterior large‐vessel occlusion endovascular therapy first‐pass successful reperfusion intravenous tirofiban |
| title | Effect of Intravenous Tirofiban Versus Placebo on First‐Pass Successful Reperfusion in Endovascular Stroke Thrombectomy: Insights From the RESCUE BT Randomized Clinical Trial |
| title_full | Effect of Intravenous Tirofiban Versus Placebo on First‐Pass Successful Reperfusion in Endovascular Stroke Thrombectomy: Insights From the RESCUE BT Randomized Clinical Trial |
| title_fullStr | Effect of Intravenous Tirofiban Versus Placebo on First‐Pass Successful Reperfusion in Endovascular Stroke Thrombectomy: Insights From the RESCUE BT Randomized Clinical Trial |
| title_full_unstemmed | Effect of Intravenous Tirofiban Versus Placebo on First‐Pass Successful Reperfusion in Endovascular Stroke Thrombectomy: Insights From the RESCUE BT Randomized Clinical Trial |
| title_short | Effect of Intravenous Tirofiban Versus Placebo on First‐Pass Successful Reperfusion in Endovascular Stroke Thrombectomy: Insights From the RESCUE BT Randomized Clinical Trial |
| title_sort | effect of intravenous tirofiban versus placebo on first pass successful reperfusion in endovascular stroke thrombectomy insights from the rescue bt randomized clinical trial |
| topic | acute ischemic stroke anterior large‐vessel occlusion endovascular therapy first‐pass successful reperfusion intravenous tirofiban |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.036350 |
| work_keys_str_mv | AT junjieyuan effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT hanmingge effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT zhaojuntao effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT huijiean effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT qinhan effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT jeffreylsaver effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT thanhnnguyen effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT siminzhou effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT anmao effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT yueluwu effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT raulgomesnogueira effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT yaxuansun effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT shunfujiang effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT lipingwei effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT xinminfu effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT yongjiebai effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT shunyuyang effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT weihu effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT gulingzhang effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT chengdepan effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT shuaizhang effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT linqiao effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT qiongchen effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT hongfeisang effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT zhongmingqiu effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT fengfuwu effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT mingzechang effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial AT zhongfanruan effectofintravenoustirofibanversusplaceboonfirstpasssuccessfulreperfusioninendovascularstrokethrombectomyinsightsfromtherescuebtrandomizedclinicaltrial |