2026 Southeastern Residency Conference

Title: Tirofiban use following mechanical thrombectomy with emergent stent placement in acute ischemic stroke
Author Names: Taylor Dodd, Mallory Stringer, Eric Shaw
Resident E-mail: [email protected]

Background
Tandem lesions are present in 15-25% of all acute ischemic strokes (AIS) presenting with a large vessel occlusion (LVO) and are associated with increased morbidity and mortality. Treatment of tandem lesions is not standardized, but may include intra-arterial thrombolysis, balloon angioplasty, and/or emergent stent placement during mechanical thrombectomy. Emergent stent placement requires antiplatelet therapy which may include glycoprotein (GP) IIb/IIIa inhibitors (e.g. tirofiban), aspirin, and/or P2Y12 inhibitors. Currently, there is inconsistent data regarding the dosing and duration of tirofiban infusion following mechanical thrombectomy with emergent stent placement in AIS. Retrospective data suggests similar rates of symptomatic intracranial hemorrhage (ICH), mortality, and reperfusion rates with tirofiban use compared to without tirofiban. The study objective is to evaluate the safety and efficacy of tirofiban followed by dual antiplatelet therapy (DAPT) compared to antiplatelet therapy alone in AIS patients post mechanical thrombectomy with emergent stent placement.

Methods
This was a single-center retrospective study conducted at a 711-bed DNV certified comprehensive stroke academic medical center. Adults admitted to the neurovascular intensive care unit (ICU) for AIS following mechanical thrombectomy and emergent stent placement that received tirofiban and/or antiplatelet therapy were included. Protected populations were excluded. The primary outcome was symptomatic ICH, defined as ICH on imaging with any of the following: need for neurosurgical intervention, intubation, decrease in Glasgow Coma Scale score ≥ 2 within 24 hours of tirofiban or DAPT. Secondary outcomes included any ICH, hospital and ICU length of stay (LOS), successful reperfusion (defined as a thrombolysis in cerebral infarction (TICI) score ≥ 2b), neurologic improvement (change in modified Rankin scale (mRS) from admission to discharge), and all-cause mortality.

Results
In this study, 56 patients were included with 27 patients in the tirofiban group and 29 patients in the group without tirofiban. Four patients (14.8%) in the tirofiban group compared to none in the without tirofiban group experienced symptomatic ICH within 24 hours of receiving tirofiban or DAPT (p<0.001). Any ICH was more prevalent in the tirofiban group compared to without tirofiban (51.9% vs. 6.9%, p<0.001). Hospital LOS (6.9 days vs. 6.1 days, p=0.386) and ICU LOS (3.8 vs. 3.7 p=0.444) were similar between groups. Successful reperfusion was achieved in 92% of patients in the tirofiban group compared to 84.6% in the without tirofiban group (p=0.668). Changes in mRS were not statistically different between groups (p=0.733). All-cause mortality was similar between groups (22.2% vs. 20.7%, p=0.837).

Conclusions
In our study population, the use of tirofiban had more ICH compared to patients not receiving tirofiban in AIS patients following mechanical thrombectomy and emergent stent placement.