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BACKGROUND: Approximately half of patients who achieve successful reperfusion do not achieve functional independence. The present study sought to investigate the clinical outcomes and safety of intraarterial or intravenous tirofiban as adjunct therapy in patients with acute basilar artery occlusion who had achieved successful recanalization with endovascular treatment. METHODS AND RESULTS: In the national, prospective BASILAR (Endovascular Treatment for Acute Basilar Artery Occlusion Study) registry, 458 patients who met inclusion criteria were divided into 3 groups based on tirofiban administration (no tirofiban, n=262; intravenous tirofiban, n=101; intraarterial+intravenous tirofiban, n=95). Their clinical outcomes were compared with 90-day modified Rankin Scale scores. Adjusted odds ratios (aORs) and 95% CIs were obtained by logistic regression models and propensity score matching. Safety outcomes included any intracranial hemorrhage (ICH), symptomatic ICH, and mortality. Among 458 included patients, 184 (40.2%) achieved a favorable outcome (modified Rankin Scale score 0-3). There were no differences between the intravenous tirofiban group and the no tirofiban group in terms of safety and clinical outcomes (all P>0.05). Compared with the no tirofiban group, the intraarterial+intravenous tirofiban group had higher odds of 90-day modified Rankin Scale score 0 to 3 (aOR, 2.44 [95% CI, 1.30-4.64], P=0.006) and lower 3-month mortality (aOR, 0.38 [95% CI, 0.19-0.71], P=0.002) without an increase in any ICH (aOR, 0.34 [95% CI, 0.09-1.01], P=0.07) or symptomatic ICH (aOR, 0.23 [95% CI, 0.03-0.90], P=0.05). Similar results of intraarterial+intravenous tirofiban on improving clinical outcomes were detected in novel cohorts constructed by propensity score matching. CONCLUSIONS: Intraarterial+intravenous rather than intravenous tirofiban improved clinical outcomes without increasing the frequency of symptomatic ICH among patients with basilar artery occlusion after successful endovascular treatment. Further studies are needed to delineate the roles of intraarterial+intravenous tirofiban in patients with basilar artery occlusion receiving endovascular treatment.

Objective To investigate the efficacy and safety of mechanical thrombectomy in patients with acute progressive ischemic stroke with large vessel occlusion in the anterior circulation. Methods From January 2020 to April 2023, 414 patients with acute progressive ischemic stroke with large vessel occlusion in the anterior cirulation in Hebei General Hospital were included. According to the time of onset and whether the patients underwent mechanical thrombectomy, the patients were divided into direct mechanical thrombectomy group (n = 293), progressive stroke mechanical thrombectomy group (n =45), and standard medical treatment group (n = 76). The modified Rankin Scale (mRS) and modified Thrombolysis in Cerebral Infarction (mTICI) were used to evaluate neurological prognosis and vascular recanalization. The incidence of symptomatic intracranial hemorrhage after treatment and 3⁃month all⁃cause mortality were recorded. Results There was a statistically significant difference in neurological prognosis among the 3 groups (χ2 = 19.572, P = 0.000). The rate of good prognosis in standard medical treatment group was lower than that progressive stroke mechanical thrombectomy group (Z = ⁃ 2.829, P = 0.005) and direct mechanical thrombectomy group (Z = ⁃ 4.422, P = 0.000), while there was no statistically significant difference in the rate of good prognosis between direct mechanical thrombectomy group and progressive stroke mechanical thrombectomy group (Z = ⁃ 0.525, P = 0.600). Logistic regression analysis showed that high National Institutes of Health Stroke Scale (NIHSS) score before treatment (OR = 1.298, 95%CI: 1.216- 1.385; P = 0.000) and standard medical treatment (OR = 7.572, 95%CI: 3.048-18.809; P = 0.000) were the risk factors for poor prognosis, and direct mechanical thrombectomy was the protective factor for good prognosis (OR = 0.431, 95%CI: 0.212-0.879; P = 0.021). There was no statistically significant difference in the vascular recanalization rate between progressive stroke mechanical thrombectomy group and direct mechanical thrombectomy group (χ2 = 0.218, P = 0.640). There was a statistically significant difference in the incidence of symptomatic intracranial hemorrhage after treatment among the 3 groups (χ2 = 6.575, P = 0.037), and direct mechanical thrombectomy group was higher than that of standard medical treatment group (Z = ⁃ 2.376, P = 0.018). There was no statistically significant difference in the 3⁃month all⁃cause mortality (χ2 = 5.178, P = 0.075). Conclusions Mechanical thrombectomy is feasible in patients with acute progressive ischemic stroke with large vessel occlusion in the anterior circulation, and has a good efficacy and safety.

Objective To evaluate the long⁃term prognosis in patients with acute ischemic stroke due to large vessel occlusion presenting beyond the conventional time window (> 24 h) who received endovascular treatment (EVT) combined with best medical treatment (BMT), compared to those treated with BMT alone. Methods This study included 158 patients from a prospective cohort of acute ischemic stroke due to large vessel occlusion were conducted at Tianjin Huanhu Hospital from November 2021 to July 2023. The 158 patients with anterior circulation large vessel occlusion were divided into received EVT combined with BMT (EVT group, n = 70) and received BMT alone (BMT group, n = 88). Long ⁃ term neurological prognosis was assessed using the modified Rankin Scale (mRS) 12 months after onset. Univariate and multivariate stepwise Logistic regression analyses were useded to investigated the risk factors of long⁃term neurological prognosis. Sensitivity analyses were performed using propensity score matching (PSM) and multiple imputation (MI). Results Logistic regression analysis showed that EVT was a protective factor for good long ⁃term neurological prognosis (mRS score ≤ 2; OR = 3.110, 95%CI: 1.460- 6.620, P = 0.003), increasing age (OR = 0.955, 95%CI: 0.924-0.987; P = 0.007) and hypertension (OR = 0.418, 95%CI: 0.187-0.936; P = 0.034) were risk factors. In the sensitivity analyses of the primary outcome, both the PSM and MI datasets showed that the proportion of patients with a good long ⁃ term neurological prognosis was significantly higher in the EVT group compared to the BMT group (PSM: aOR = 3.610, 95%CI: 1.370-9.550, P = 0.010; MI: aOR = 3.870, 95%CI: 1.780-8.440, P = 0.000). The results were consistent with the main analysis. Conclusions Compared to BMT group, EVT group patients with acute ischemic stroke due to large vessel occlusion presenting beyond the conventional time window was demonstrated a significantly better long⁃term neurological prognosis.