Luiz Fábio Silva Ribeiro, Lucas Rezende de Freitas, Ofonime Chantal Udoma-Udofa, Júlia Dos Santos Monteiro, Yasmin Picanço Silva, Walter Fagundes
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Secondary outcomes included 90-day mRS 0-1, mRS score at 90 days, successful reperfusion, 90-day mortality, postprocedural reocclusion, and symptomatic/non-symptomatic intracranial hemorrhage (ICH). Subgroup analyses evaluated tirofiban administration routes (intravenous, intra-arterial, or combined).</p><p><strong>Results: </strong>Thirteen studies comprising 3,572 patients were included. Intravenous tirofiban significantly increased mRS 0-2 (RR 1.26 [95% CI 1.13; 1.42]; p < 0.0001, I²= 0%), mRS 0-1(RR 1.24 [95% CI 1.05; 1.45]; p = 0.0098, I² = 0%), reduced mRS score by 0.58 points ([95% CI -0.99; -0.17]; p = 0.006, I²= 66%) and decreased mortality (RR 0.68 [95% CI 0.57; 0.80]; p < 0.0001, I²= 8%) at 90 days compared to control. Tirofiban overall reduced postprocedural reocclusion relative to control (RR 0.36 [95% CI 0.14; 0.94]; p = 0.036, I²= 73%). No significant differences were observed in successful reperfusion or ICH.</p><p><strong>Conclusion: </strong>Intravenous tirofiban demonstrated an efficacy and safety profile, improving functional recovery and reducing mortality. Tirofiban overall reduced postprocedural reocclusion compared to control. No significant differences were found between groups in successful reperfusion or ICH. These findings support tirofiban as a safe and effective EVT adjunct.</p><p><strong>Systematic review protocol: </strong>PROSPERO (CRD42024606522).</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":"241-255"},"PeriodicalIF":2.4000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy and safety of tirofiban in acute ischemic stroke due to intracranial atherosclerotic disease for patients undergoing endovascular treatment: a systematic review and meta-analysis.\",\"authors\":\"Luiz Fábio Silva Ribeiro, Lucas Rezende de Freitas, Ofonime Chantal Udoma-Udofa, Júlia Dos Santos Monteiro, Yasmin Picanço Silva, Walter Fagundes\",\"doi\":\"10.1007/s00234-024-03537-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Tirofiban has emerged as an adjunct therapy for acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). However, its benefits for AIS patients with intracranial atherosclerotic disease (ICAD) remains unclear. This meta-analysis evaluates its efficacy and safety in ICAD-related AIS patients undergoing EVT.</p><p><strong>Methods: </strong>We searched PubMed, Cochrane, and Embase up to September, 2024, for studies comparing tirofiban to placebo or no intervention in ICAD-related AIS. Primary outcome was modified Rankin Scale (mRS) 0-2 at 90 days. Secondary outcomes included 90-day mRS 0-1, mRS score at 90 days, successful reperfusion, 90-day mortality, postprocedural reocclusion, and symptomatic/non-symptomatic intracranial hemorrhage (ICH). Subgroup analyses evaluated tirofiban administration routes (intravenous, intra-arterial, or combined).</p><p><strong>Results: </strong>Thirteen studies comprising 3,572 patients were included. Intravenous tirofiban significantly increased mRS 0-2 (RR 1.26 [95% CI 1.13; 1.42]; p < 0.0001, I²= 0%), mRS 0-1(RR 1.24 [95% CI 1.05; 1.45]; p = 0.0098, I² = 0%), reduced mRS score by 0.58 points ([95% CI -0.99; -0.17]; p = 0.006, I²= 66%) and decreased mortality (RR 0.68 [95% CI 0.57; 0.80]; p < 0.0001, I²= 8%) at 90 days compared to control. Tirofiban overall reduced postprocedural reocclusion relative to control (RR 0.36 [95% CI 0.14; 0.94]; p = 0.036, I²= 73%). No significant differences were observed in successful reperfusion or ICH.</p><p><strong>Conclusion: </strong>Intravenous tirofiban demonstrated an efficacy and safety profile, improving functional recovery and reducing mortality. Tirofiban overall reduced postprocedural reocclusion compared to control. No significant differences were found between groups in successful reperfusion or ICH. 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引用次数: 0
摘要
目的：替罗非班已成为急性缺血性卒中（AIS）患者接受血管内治疗（EVT）的辅助治疗。然而，其对伴有颅内动脉粥样硬化性疾病（ICAD）的AIS患者的益处尚不清楚。本荟萃分析评估其在icad相关AIS患者行EVT的疗效和安全性。方法：我们检索了PubMed、Cochrane和Embase，截至2024年9月，以比较替罗非班与安慰剂或无干预治疗icad相关AIS的研究。主要观察指标为90天的改良Rankin量表（mRS） 0-2。次要结局包括90天mRS 0-1、90天mRS评分、再灌注成功、90天死亡率、术后再闭塞、有症状/无症状颅内出血（ICH）。亚组分析评估替罗非班给药途径（静脉注射、动脉注射或联合用药）。结果：纳入13项研究，包括3,572例患者。静脉注射替罗非班显著增加mRS 0-2 (RR 1.26 [95% CI 1.13；1.42);结论：静脉注射替罗非班具有有效性和安全性，可改善功能恢复并降低死亡率。与对照组相比，替罗非班总体上减少了术后再闭塞。各组再灌注成功或脑出血无显著差异。这些发现支持替罗非班作为一种安全有效的EVT辅助药物。系统评价方案：PROSPERO （CRD42024606522）。
Efficacy and safety of tirofiban in acute ischemic stroke due to intracranial atherosclerotic disease for patients undergoing endovascular treatment: a systematic review and meta-analysis.
Purpose: Tirofiban has emerged as an adjunct therapy for acute ischemic stroke (AIS) patients undergoing endovascular treatment (EVT). However, its benefits for AIS patients with intracranial atherosclerotic disease (ICAD) remains unclear. This meta-analysis evaluates its efficacy and safety in ICAD-related AIS patients undergoing EVT.
Methods: We searched PubMed, Cochrane, and Embase up to September, 2024, for studies comparing tirofiban to placebo or no intervention in ICAD-related AIS. Primary outcome was modified Rankin Scale (mRS) 0-2 at 90 days. Secondary outcomes included 90-day mRS 0-1, mRS score at 90 days, successful reperfusion, 90-day mortality, postprocedural reocclusion, and symptomatic/non-symptomatic intracranial hemorrhage (ICH). Subgroup analyses evaluated tirofiban administration routes (intravenous, intra-arterial, or combined).
Results: Thirteen studies comprising 3,572 patients were included. Intravenous tirofiban significantly increased mRS 0-2 (RR 1.26 [95% CI 1.13; 1.42]; p < 0.0001, I²= 0%), mRS 0-1(RR 1.24 [95% CI 1.05; 1.45]; p = 0.0098, I² = 0%), reduced mRS score by 0.58 points ([95% CI -0.99; -0.17]; p = 0.006, I²= 66%) and decreased mortality (RR 0.68 [95% CI 0.57; 0.80]; p < 0.0001, I²= 8%) at 90 days compared to control. Tirofiban overall reduced postprocedural reocclusion relative to control (RR 0.36 [95% CI 0.14; 0.94]; p = 0.036, I²= 73%). No significant differences were observed in successful reperfusion or ICH.
Conclusion: Intravenous tirofiban demonstrated an efficacy and safety profile, improving functional recovery and reducing mortality. Tirofiban overall reduced postprocedural reocclusion compared to control. No significant differences were found between groups in successful reperfusion or ICH. These findings support tirofiban as a safe and effective EVT adjunct.
期刊介绍：
Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.
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