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. 2024 Sep 26;10(3):250-256.
doi: 10.4103/bc.bc_15_24. eCollection 2024 Jul-Sep.

Intravenous thrombolysis plus tirofiban versus tirofiban alone in Caucasian patients with acute anterior choroidal or paramedian pontine infarction

Moussa Toudou-Daouda  1   2 , Roger-Venant Yatwa-Zaniwe  1 , Nana-Rahamatou Aminou-Tassiou  1 , Mohamed Baby  1 , Djibril Soumah  1 , Tony Altarcha  1 , Manvel Aghasaryan  1 , Olga Laine  3 , Nicolas Chausson  1   4 , Didier Smadja  1   4
Affiliations

Intravenous thrombolysis plus tirofiban versus tirofiban alone in Caucasian patients with acute anterior choroidal or paramedian pontine infarction

Moussa Toudou-Daouda et al. Brain Circ. .

Abstract

Background: Tirofiban has been shown to be superior to aspirin in achieving functional independence at 3 months for acute ischemic stroke of atheromatous or microatheromatous origin. As intravenous thrombolysis (IVT) has previously been shown to be nonsuperior to aspirin in achieving functional independence at 3 months for anterior choroidal or paramedian pontine infarction (ACI/PPI), we aimed to compare the outcomes of Caucasian patients receiving IVT plus tirofiban (IVT + T) with those receiving tirofiban alone for acute ACI/PPI.

Methods: A retrospective study was conducted in patients aged ≥ 18 years with ACI/PPI treated in our stroke unit between December 1, 2020, and April 30, 2023, who received therapeutic intervention within 9 hours of symptom onset or after awakening with stroke symptoms. Modified Rankin Scale (mRS) ≤ 1 at 3 months was the primary endpoint. Secondary endpoints were National Institutes of Health Stroke Scale (NIHSS) ≤ 2 at day 7 or discharge and post-procedural neurological deterioration (PPND) within 72 hours. Symptomatic intracranial hemorrhage (SICH) and major systemic bleeding (MSB) were the safety measures of the study.

Results: A total of 24 patients were enrolled in the tirofiban group and 43 patients in the IVT + T group. Compared to tirofiban alone, IVT + T was associated with a higher probability of achieving mRS ≤1 at 3 months (adjusted odds ratio [aOR], 8.79; 95% confidence interval [CI], 2.06-37.52; P = 0.003) and National Institutes of Health Stroke Scale ≤2 at day 7 or discharge (aOR, 3.70; 95% CI, 1.05-12.99; P = 0.041). No significant difference was seen between the two groups in preventing postprocedural neurological deterioration. One case of SICH and two cases of MSB occurred in the IVT + T group and no cases in the tirofiban group. One case of inhospital mortality was recorded in the IVT + T group.

Conclusions: Our results showed that IVT + T may be safe and effective in Caucasian patients with acute ACI/PPI.

Keywords: Acute ischemic stroke; anterior choroidal artery; intravenous thrombolysis; paramedian pontine artery; tirofiban.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Cerebral magnetic resonance imaging showing on diffusion-weighted imaging (images a, b, c and d) infarction in the perforating vascular territory of the anterior choroidal artery
Figure 2
Figure 2
Cerebral magnetic resonance imaging showing on diffusion-weighted imaging ischemic lesions of the pons involving the ventral surface in the territory of the paramedian pontine artery
Figure 3
Figure 3
Flowchart of the study
Figure 4
Figure 4
Distribution of the Modified Rankin Scale at 3 months according to study groups. No inhospital mortality occurred in the tirofiban group at 3 months. IVT + T: Intravenous thrombolysis + tirofiban
See this image and copyright information in PMC

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