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OBJECTIVE: This study aimed to investigate whether treatment with adjunct intravenous tirofiban is associated with improved outcomes following successful reperfusion in patients with intracranial atherosclerotic stroke. METHODS: Patients with intracranial large artery atherosclerotic (LAA) stroke and an expanded Treatment in Cerebral Ischemia angiographic score of 2b50 to 3 from the Effect of Intravenous Tirofiban versus Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke (RESCUE BT) trial were included. The primary outcome was the difference in proportion of independent functional outcome (modified Rankin score of 0-2 at 90 days). Safety outcomes included the rates of symptomatic intracranial hemorrhage (sICH) and 90-day mortality. RESULTS: Among the 382 patients with intracranial LAA stroke and successful reperfusion, 175 patients (45.8%) were treated with intravenous tirofiban and 207 (54.2%) with placebo. The proportion of patients with independent functional outcome at 90 days was 54.3% (95 out of 175) with tirofiban and 44.0% (91 out of 207) with placebo (adjusted odds ratio [aOR], 1.58; 95% CI, 1.02-2.44; p = 0.04). Intravenous tirofiban was not significantly associated with an increased risk of sICH (12/175 [6.9%] vs. 11/207 [5.3%]; aOR, 1.41; 95% CI, 0.59-3.34; p = 0.44) or 90-day mortality (21/175 [12.0%] vs. 34/207 [16.4%]; aOR, 0.71; 95% CI, 0.38-1.31; p = 0.27). INTERPRETATION: Among patients with acute intracranial LAA stroke and successful reperfusion following endovascular thrombectomy, adjunct intravenous tirofiban was associated with a higher rate of independent functional outcome, without higher rates of sICH or mortality. Confirmatory randomized trials in these patients are desirable.

BACKGROUND AND OBJECTIVE: To investigate the efficacy and safety of IV infusion of tirofiban before endovascular thrombectomy for patients with large vessel occlusion due to intracranial atherosclerotic disease. The secondary objective was to identify potential mediators for the clinical effect of tirofiban. METHODS: Post hoc exploratory analysis of the Endovascular Treatment With versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke (RESCUE BT) trial, which was a randomized, double-blinded, placebo-controlled trial at 55 centers in China from October 2018 to October 2021. Patients with occlusion of the internal carotid artery or middle cerebral artery due to intracranial atherosclerosis were included. The primary efficacy outcome was the proportion of patients achieving functional independence (defined as modified Rankin scale 0-2) at 90 days. Binary logistic regression and causal mediation analyses were used to estimate the treatment effect of tirofiban and the potential mediators. RESULTS: This study included 435 patients, of whom 71.5% were men. The median age was 65 (interquartile range [IQR] 56-72) years, with a median NIH Stroke Scale of 14 (IQR 10-19). Patients in the tirofiban group had higher rates of functional independence at 90 days than patients in the placebo group (adjusted odds ratio 1.68; 95% CI 1.11-2.56, p = 0.02) without an increased risk of mortality or symptomatic intracranial hemorrhage. Tirofiban was associated with fewer thrombectomy passes (median [IQR] 1 [1-2] vs 1 [1-2], p = 0.004), which was an independent predictor of functional independence. Mediation analysis showed tirofiban-reduced thrombectomy passes explained 20.0% (95% CI 4.1%-76.0%) of the effect of tirofiban on functional independence. DISCUSSION: In this post hoc analysis of the RESCUE BT trial, tirofiban was an effective and well-tolerated adjuvant medication of endovascular thrombectomy for patients with large vessel occlusion due to intracranial atherosclerosis. These findings need to be confirmed in future trials. TRIAL REGISTRATION INFORMATION: The RESCUE BT trial was registered on the Chinese Clinical Trial Registry: chictr.org.cn, ChiCTR-INR-17014167. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that tirofiban plus endovascular therapy improves 90-day outcome for patients with large vessel occlusion due to intracranial atherosclerosis.

Objective To analyze the prognosis and risk factors of acute tandem vertebrobasilar artery occlusion (VBO) after endovascular therapy (EVT). Methods This study used the patient data from the EVT for Acute Basilar Artery Occlusion Study (BASILAR), a national multicenter clinical registry study for endovascular treatment of acute basilar artery occlusion from January 2014 to May 2019. All patients received intravascular treatment and underwent a 90 d follow-up. According to the presence of vertebral artery and basilar artery occlusion, they were divided into vertebral basilar artery occlusion (VBO) group and acute basilar artery occlusion (BAO) group. Their baseline indicators were analyzed to explore the differences in prognosis and influencing factors between the 2 groups. Results A total of 647 eligible patients were included in this study, with a median age of 64 (56, 74) years, and 74.7% of them (483) were males. Among them, 560 patients had simple basilar artery occlusion and the other 87 had basilar artery occlusion combined with severe stenosis or occlusion of the vertebral artery. There were no significant differences in the 90-day good prognosis rate (defined as mRS score of 0~3) (P=0.090) and mortality rate (P=0.890) between the VBO group and the BAO group. For the patients in the VBO group, lower NIHSS score (OR=0.898, 95% CI: 0.845~0.954, P < 0.001), higher pc-ASPECTS score (OR=1.690, 95%CI: 1.117~2.557, P=0.010), and shorter puncture to recanalization time (OR=0.990, 95%CI: 0.980~1.000, P=0.047) were independent risk factors for 90-day good prognosis. Similarly, higher NIHSS score (OR=1.094, 95%CI: 1.033~1.159, P=0.002), lower pc-ASPECTS score (OR=0.622, 95%CI: 0.438~0.882, P=0.008) and longer puncture to recanalization time (OR=1.010, 95%CI: 1.001~1.019, P=0.040) were also predictive factors for 90-day mortality in these patients. Conclusion EVT is safe and effective for acute VBO, with a good short-term prognosis. NIHSS score, pc-ASPECTS score, and puncture to recanalization time are independent predictors for 90-day good prognosis in VBO patients, and are also predictors of 90-day mortality rate.

Objective: The impact of true first‐pass effect (T‐FPE, achieving substantial recanalization with extended thrombolysis in cerebral infarction; eTICI 3 after 1 thrombectomy) and outcomes on acute ischemic stroke (AIS) with large ischemic core remains uncertain. We aimed to study the association between T‐FPE and outcomes in AIS patients with large core infarct through a real‐world multicenter study. Methods: From a prospective multicentric registry, we collected the data of all consecutive acute stroke patients with a large ischemic core who underwent thrombectomy and compared the outcomes of patients who achieved T‐FPE and those who did not. In addition, we compared the outcomes of patients with different numbers of thrombectomy pass to identify the effectiveness of T‐FPE. Multivariate analysis was performed to determine the predictors of T‐FPE. The primary outcome was good functional outcome (modified Rankin Scale score; mRS 0–3) at 90 days. Safety outcomes included a 90‐day mortality and symptomatic intracerebral hemorrhage within 48 hours after thrombectomy. Results: Between November 2021 and February 2023, 447 eligible patients at 38 stroke centers were enrolled. Out of 447 thrombectomy patients, T‐FPE was achieved in 102 individuals (22.8%). T‐FPE was significantly associated with a higher proportion of good functional outcome (mRS 0–3 at 3 months, OR 2.221, 95% CI 1.418–3.479, p < 0.001) and lower mortality than non‐T‐FPE patients (31.4% vs. 45.5%, p = 0.012). The occlusion sites and lower DBP were strong predictors of T‐FPE. Interpretation: T‐FPE was associated with favorable outcomes at 90 days in AIS patients with a large ischemic core who underwent EVT. [ABSTRACT FROM AUTHOR]

Background: Symptomatic intracranial hemorrhage (sICH) is a fatal complication after endovascular treatment (EVT) for acute large vessel occlusive (LVO) stroke. The aim of this study was to investigate the association between hyperglycemia and outcomes in patients with postprocedural sICH. Methods: Of the 2567 patients with AIS who underwent EVT from two large multicenter randomized trials and two prospective multicenter registry studies, 324 patients occurred sICH with documented admission glucose were included in this study. The primary outcome was functional independence (defined as a modified Rankin Scale score of 0 to 2) at 90 days. Secondary outcomes included mRS score of 0 to 3, 0 to 1, and mRS score at 90 days. Safety outcome was the mortality within 90 days. Admission hyperglycemia was defined as a plasma blood glucose ≥ 7.8 mmol/L (140 mg/dL) in our analysis. Results: Of 324 eligible participants included in this study, hyperglycemia was observed in 130 (40.1%) patients. The median age was 67 (IQR, 58– 75) years, and median blood glucose level was 7.1 (IQR, 6.0– 9.3) mmol/L. After adjusting for confounding variables, admission hyperglycemia was associated with decreased odds of functional independence (adjusted odds ratio[OR] 0.34; 95% CI 0.17– 0.68; P= 0.003), decreased odds of favorable outcome (adjusted OR 0.31; 95% CI 0.16– 0.58; P < 0.001) and increased odds of mortality (adjusted OR 2.56; 95% CI 1.47– 4.45; P = 0.001) at 90 days. After 1:1 propensity score matching analysis, the results were consistent with multivariable logistic regression analysis. Conclusion: In patients who suffered sICH after EVT for acute large vessel occlusive stroke, hyperglycemia is a strong predictor of poor clinical outcome and mortality at 90 days. [ABSTRACT FROM AUTHOR]

The effectiveness and safety of human urinary kallidinogenase (HUK) in acute ischemic stroke (AIS) patients undergoing endovascular therapy (EVT) due to large vessel occlusion (LVO) was unclear. A pooled analysis was performed using individual data from the DEVT and RESCUE BT trials. Patients were divided into two groups based on HUK treatment. The primary outcome was the 90-day modified Rankin Scale (mRS) score. Safety outcomes included 90-day mortality and symptomatic intracranial hemorrhage (sICH) within 48 hours. A total of 1174 patients were included in the study. Of these, 150 (12.8%) patients received HUK. The adjusted common odds ratio (OR) of the mRS score was 1.458 (95% confidence interval [CI] = 1.072–1.983; p = 0.016) favoring HUK. The incidence of sICH (2.0% vs. 8.6%; adjusted OR: 0.198; 95% CI: 0.061–0.638; p = 0.007) and mortality (11.3% vs. 18.5%; adjusted OR: 0.496; 95% CI: 0.286–0.862; p = 0.013) was lower in HUK group than non-HUK group. This association was consistent with propensity score-matching and the inverse probability of treatment weighting analysis. In conclusion, HUK was safe and associated with a preferable prognosis in AIS patients due to LVO in the anterior circulation. [ABSTRACT FROM AUTHOR]