Abstract 100: Endovascular Treatment with Intravenous Tirofiban or Alteplase Versus Endovascular Treatment Alone for Acute Ischemic Stroke with Large Vessel Occlusion: A Pooled Analysis of the Devt and Rescue Bt Trials

Background: In acute ischemic stroke patients with large vessel occlusion, the role of intravenous tirofiban or alteplase as an adjunct to endovascular treatment (EVT) is still uncertain. Methods: This post hoc analysis used data from 467 patients included in two multicenter, randomized clinical trials that assessed intravenous adjunctive medications in stroke thrombectomy (DEVT and RESCUE BT). Patients were treated with EVT alone (EVT-alone group), intravenous tirofiban plus EVT (tirofiban+EVT group), and intravenous alteplase plus EVT (alteplase+EVT group). The primary outcome was functional independence (modified Rankin scale score 0-2) at 90 days. Safety outcomes included intracranial hemorrhage and mortality. Results: Of 467 patients included in the cohort, there were 172, 172, and 123 patients in EVT-alone, tirofiban+EVT, and alteplase+EVT group, respectively. Patients in the alteplase+EVT group were less likely to achieve functional independence than patients in the tirofiban+EVT group (adjusted risk ratio [RR], 0.80; 95% confidence interval [CI], 0.65-0.99; P = 0.04). Patients in the EVT-alone group compared with the tirofiban+EVT group (adjusted RR, 1.12; 95% CI, 0.92-1.36; P = 0.27) or the alteplase+EVT group (adjusted RR, 0.81; 95% CI, 0.65-1.02; P = 0.07) were similarly likely to obtain functional independence. Patients in the alteplase+EVT group had a higher risk of any intracranial hemorrhage than in the EVT-alone group (adjusted RR, 1.49; 95% CI, 1.03-2.14; P = 0.03) and tirofiban+EVT group (adjusted RR, 1.49; 95% CI, 1.02-2.18; P = 0.04). No significant difference was detected in the incidence of symptomatic intracranial hemorrhage and mortality among the three groups. Conclusions: Tirofiban before thrombectomy is associated with a better functional outcome and lower risk of any intracranial hemorrhage than alteplase among patients with large vessel occlusion treated within 4.5 hours after stroke onset. Trial Registration: chictr.org.cn, ChiCTR-IOR-17013568 and ChiCTR-INR-17014167.