Use of Tirofiban in Endovascular Thrombectomy: More Questions than Answers

Excerpt

Large vessel occlusion (LVO) strokes are mostly caused by cardioembolism, intracranial (ICAD) or extracranial atherosclerotic disease (ECAD). Although large artery atherosclerotic LVOs are less common than those caused by cardioembolism, endovascular therapy (EVT) for these conditions could be challenging. Immediate re-occlusion of ICAD/ECAD lesions is common due to thrombogenic plaques or elastic recoiling following thrombectomy and/or angioplasty [1]. Ongoing artery-to-artery embolism may also result in new tandem occlusions downstream to the lesion. As a result, emergent intra- or extracranial stenting is frequently considered to optimize antegrade flow [2]. These challenges prompt the need for a rapid-onset, potent, and safe periprocedural antiplatelet agent. In practice, tirofiban, a glycoprotein IIb/IIIb inhibitor, is commonly given in these scenarios. Yet, evidence regarding its efficacy, safety, and hemorrhagic risk with intravenous thrombolytic therapy (IVT) is relatively scarce. …