Background: Acute ischemic stroke (AIS) is a major cause of disability and death in the United States. Early medical management for AIS is essential for reducing morbidity and mortality. While mechanical thrombectomy (MT) has been shown to improve outcomes in patients with large-vessel occlusions (LVO), complications such as re-occlusion and early neurological deterioration (END) continue to pose significant challenges. Glycoprotein IIb/IIIa inhibitors, such as tirofiban, have demonstrated potential benefit in a subset of patients following thrombolytic and/or MT; however, data supporting their routine use post-thrombectomy is limited. Piedmont Columbus Regional Midtown (PCRM) currently uses tirofiban in select post-thrombectomy patients at high risk of re-occlusion , determined by the treating physician based on clinical presentation and angiographic findings. This study aims to evaluate the safety and efficacy of PCRM’s targeted post-thrombectomy tirofiban strategy compared to a matched cohort from the pre-tirofiban era, with a focus on functional outcomes and END.
Methods: A retrospective matched cohort study was conducted on adult patients with LVO stroke who received tirofiban within 3 hours of MT at Piedmont Columbus Regional Medical between January 1, 2024 and December 31, 2025. The primary outcome objective was incidence of END, defined as increase in National Institutes of Stroke Scale (NIHSS) of > 2 within 24 ± 6 hours of mechanical thrombectomy (MT). Secondary objectives included frequency of re-intervention within 48 hours of initial MT, modified Rankin Scale (mRS) at discharge or 90-days post initial intervention, and rate of symptomatic intracranial hemorrhage. A control group was constructed using exact matching on key pre-treatment variables. In total, six patients were included in the treatment group and twelve patients were included in the control group. Data were analyzed using t-tests for continuous variables and Fisher’s exact test for categorical variables.
Results: For the primary objective of END, 50% of patients in the treatment group meet END criteria versus 20% in the control group. For secondary objectives, one patient in the control group required re-intervention while no patients in the treatment group required re-intervention. All treatment group participants had a discharge/90-day mRS of 3-5 compared to 66.7% of control group participants. No patients in either group experienced symptomatic hemorrhagic conversion. None of these outcomes were found to be statistically significant.
Conclusion: There were no statistically significant differences in assessed safety or functional outcomes between groups.
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