静脉溶栓桥接血管内治疗术中使用替罗非班治疗急性前循环大血管闭塞性脑梗死的安全性研究

Safety of tirofiban in patients with acute anterior circulation large vessel occlusive cerebral infarction during bridging endovascular treatment after intravenous thrombolysis

目的探讨急性前循环大血管闭塞性脑梗死患者接受静脉溶栓(IVT)后桥接血管内治疗(EVT)术中使用替罗非班的安全性。方法选择苏州大学附属第一医院介入科自2017年1月至2022年1月采用IVT桥接EVT治疗的203例急性前循环大血管闭塞性脑梗死患者为研究对象。根据患者EVT术中是否使用替罗非班将患者分为替罗非班组(80例)与非替罗非班组(123例),将使用替罗非班的患者根据是否行急诊支架植入术分为支架植入组(52例)与非支架植入组(28例)。分别统计比较2组患者的临床资料、安全性评价指标[包括术后24 h、2~3 d及90 d颅内出血(ICH)或术后3~90 d新发ICH发生率,致死性ICH发生率,术后90 d死亡率]和预后的差异。结果(1)与非替罗非班组比较,替罗非班组男性、串联闭塞、球囊扩张及支架植入者占比较高,心房颤动者占比较低,手术时间较长,脑卒中类型的分布不同,差异均有统计学意义(P<0.05)。替罗非班与非替罗非班组患者术后24 h ICH发生率、术后2~3 d ICH发生率、术后90 d ICH发生率、致死性ICH发生率、术后90 d死亡率以及术后90 d预后良好率的差异均无统计学意义(P>0.05)。(2)与非支架植入组比较,支架植入组患者串联闭塞、球囊扩张者占比较高,差异均有统计学意义(P<0.05)。支架植入组与非支架植入组患者术后90 d预后良好率、术后3~90 d新发ICH发生率的差异均无统计学意义(P>0.05)。与非支架植入组比较,支架植入组患者术后24 h、2~3 d及90 d ICH发生率,致死性ICH发生率,术后90 d死亡率均较高,差异均有统计学意义(P<0.05)。结论急性前循环大血管闭塞性脑梗死患者接受IVT后桥接EVT术中使用替罗非班总体是安全的,但如果术中再行急诊支架植入术则会导致ICH发生率及死亡率增加。

Objective To investigate the safety of tirofiban in patients with anterior circulation acute large vessel occlusion cerebral infarction during bridging endovascular treatment(EVT)after intravenous thrombolysis(IVT).Methods Two hundred and three patients received bridging EVT after IVT in Department of Intervention,First Affiliated Hospital of Soochow University from January 2017 to January 2022 were chosen.Patients were divided into tirofiban group(n=80)and non-tirofiban group(n=123)according to whether or not tirofiban was used during EVT,and then patients from tirofiban group were subdivided into stent implantation group(n=52)and non-stent implantation group(n=28)according to whether or not emergency stent implantation was performed.The clinical data,safety indexes(intracranial hemorrhage[ICH]rate 24 h,2-3 d,and 90 d after EVT,new ICH incidence 3-90 d after EVT,fatal ICH rate,and mortality 90 d after EVT),and prognoses 90 d after EVT were compared.Results(1)Compared with the non-tirofiban group,the tirofiban group had significantly higher proportions of males,and patients with tandem occlusion,balloon dilation or stent implantation,and statistically lower proportion of patients with atrial fibrillation,significantly longer surgical time,and significantly different distribution of stroke types(P<0.05).No significant differences were noted in ICH incidences 24 h after EVT,2-3 d after EVT and 90 d after EVT,fatal ICH incidence,mortality incidence 90 d after EVT,or good prognosis rate 90 d after surgery between tirofiban group and non-tirofiban group(P>0.05).(2)Patients in the stent implantation group had significantly higher percentages of tandem occlusion and balloon dilation compared with those in the non-stent implantation group(P<0.05).No significant difference was noted in good prognosis rate 90 d after EVT or new ICH incidence 3-90 d after EVT between the stent implantation group and the non-stent implantation group(P>0.05).Compared with the non-stent implantation group,the stent implantation group had statistically higher ICH incidences 24 h after EVT,2-3 d after EVT,and 90 d after EVT,significantly higher fatal ICH incidence and mortality 90 d after EVT(P<0.05).Conclusion Tirofiban is safe in patients with anterior circulation acute large vessel occlusion cerebral infarction during EVT after IVT;however,if emergency stent implantation is performed,it will lead to increased intracranial hemorrhage and mortality.