Tirofiban Boosts Reperfusion Success and Reduces Disability in Stroke Patients, RESCUE BT Trial Finds
China: The RESCUE BT trial found that intravenous (IV) tirofiban administered before endovascular thrombectomy significantly improved first-pass successful reperfusion (FPSR) rates in patients with acute ischemic stroke caused by large-vessel occlusion. The findings were published online in the Journal of the American Heart Association on November 4, 2024.
"Among 948 patients, FPSR was achieved in 30.5% of those treated with tirofiban, compared to 23.5% in the placebo group. This enhanced reperfusion was associated with better functional outcomes at 90 days," the researchers reported.
First-pass successful reperfusion (FPSR), which refers to achieving complete and successful reperfusion after a single thrombectomy pass, is a strong predictor of favorable outcomes in patients with acute ischemic stroke due to large-vessel occlusion. Based on this, Junjie Yuan, Department of Critical Care Medicine General Hospital of Southern Theatre Command, PLA Guangzhou China, and colleagues aimed to assess whether intravenous tirofiban could increase the rate of FPSR in patients with acute anterior large-vessel occlusion stroke.
For this purpose, the researchers analyzed data from patients with acute large-vessel occlusion stroke who presented within 24 hours and underwent endovascular thrombectomy as part of the RESCUE BT (Intravenous Tirofiban for Patients With Large Vessel Occlusion Stroke) clinical trial. While the main analysis of the trial was neutral, it randomized patients to receive either intravenous tirofiban or a placebo before thrombectomy.
The primary endpoint was FPSR, defined as successful reperfusion (using the extended thrombolysis in cerebral infarction scale of 2b50, 2c, or 3) achieved after the first thrombectomy attempt. A modified Poisson regression analysis was conducted to assess the association between intravenous tirofiban treatment and FPSR. Among the 948 enrolled patients, 463 were randomized to receive tirofiban and 485 to the placebo group. The mean age of participants was 67 years, and 41.0% of the patients were women.
The findings from the study can be summarized as follows:
- First-pass successful reperfusion (FPSR):
- FPSR was achieved more frequently in the tirofiban group compared to the placebo group (30.5% versus 23.5%).
- The adjusted risk ratio for FPSR in the tirofiban group was 1.24, with statistical significance.
- Functional Outcomes at 90 Days:
- FPSR was associated with a favorable shift to lower modified Rankin Scale (mRS) disability levels at 90 days.
- The common odds ratio for a favorable shift in disability was 1.42, with statistical significance.
In the post hoc analysis of the RESCUE BT randomized clinical trial, intravenous tirofiban administration before endovascular thrombectomy was found to facilitate the achievement of FPSR in patients with acute ischemic stroke due to large-vessel occlusion. Achieving FPSR, in turn, was linked to lower levels of global disability at 90 days.
"These findings suggest that tirofiban may serve as an effective periprocedural adjunct to enhance FPSR rates during endovascular thrombectomy. However, further confirmation through future trials is needed to validate these results," the researchers concluded.
Reference:
https://doi.org/10.1161/JAHA.124.03635
