Acute ischemic stroke
Conditions
Interventions
Intervention group:Immediate local intra-arterial tirofiban infusion after complete reperfusion
Control group:After intraoperative confirmation of achieving eTICI 2c–3 complete recanalization, intra-arterial tirofiban infusion is not performed
the rest of the perioperative and postoperative management is carried out according to guidelines and the stroke pathways of each center.
Sponsors
Shandong Provincial Hospital
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Inclusion criteria
Inclusion criteria: 1. Age =18 years; 2. Time from last known well to arterial puncture 0–24 h; 3. Preprocedural imaging confirming anterior-circulation large-vessel occlusion, defined as occlusion of the intracranial internal carotid artery or the M1 segment or dominant M2 trunk of the middle cerebral artery; 4. Baseline NIHSS score 6–25; 5. Baseline ASPECTS =6 on CT or DWI; 6. Pre-stroke mRS score =1; 7. Complete reperfusion of eTICI 2c–3 achieved after mechanical thrombectomy, or spontaneous reperfusion to eTICI 2c–3 confirmed by intraoperative angiography without the need for further device thrombectomy; 8. Embolic occlusion, defined as no residual fixed stenosis in the culprit vessel after the procedure; 9. Patients are eligible regardless of whether intravenous thrombolysis was administered; 10. Written informed consent signed by the patient or legally authorized representative.
Exclusion criteria
Exclusion criteria: 1. Pregnant or breastfeeding women; 2. Active bleeding within the past 1 month (eg, gastrointestinal or urinary tract bleeding) or known severe bleeding tendency; 3. Major underlying disease with an expected life expectancy of 1.7, or use of direct oral anticoagulants without meeting the center-specified discontinuation or testing requirements; 6. Platelet count 22.2 mmol/L and not correctable within a short period; 8. Severe renal insufficiency (eGFR 2.5 mg/dL); 9. Systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg despite treatment; 10. Imaging-confirmed intracranial hemorrhage, or intracranial aneurysm, arteriovenous malformation, brain tumor with significant mass effect, or other lesions associated with a high risk of bleeding, or bilateral acute cerebral infarction or multiple intracranial arterial occlusive lesions; 11. Severe intraprocedural complications such as vessel rupture, dissection, contrast extravasation, or other events requiring deviation from the standard antithrombotic strategy; 12. Need for balloon angioplasty, permanent stent implantation, or planned initiation of antiplatelet or anticoagulant therapy within 24 h after endovascular treatment; 13. More than 3 thrombectomy device passes or puncture-to-reperfusion time >90 min (to reduce procedure-related injury and confounding); 14. Intraprocedural intravenous heparin bolus use (except heparinized saline flush); 15. Suspected septic embolus or infective endocarditis; 16. Severe allergy to contrast agents or tirofiban.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Proportion of favorable functional outcome at 90 days (mRS 0–1); | — |
Secondary
| Measure | Time frame |
|---|---|
| NIHSS SCORE; | — |
Countries
China
Contacts
Public ContactQinjian Sun
Shandong Provincial Hospital
Outcome results
None listed