Xiangxiang Peng,1,* Changwei Guo,2,* Jie Yang,2 Shitao Fan,2 Xu Xu,2 Jinfu Ma,2 Zhixi Wang,2 Shihai Yang,2 Wenjie Zi,2 Xianjun Huang,1 Hongjun Wang3 

1Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, People’s Republic of China; 2Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China; 3Department of Neurology, Chongqing Fengdu People’s Hospital, Chongqing, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xianjun Huang, Department of Neurology, Yijishan Hospital of Wannan Medical College, No. 92 Zheshan Road, Wuhu, Anhui Province, 241000, People’s Republic of China, Tel +86-553-5739543, Email doctorhuangxj@hotmail.com Hongjun Wang, Department of Neurology, Chongqing Fengdu People’s Hospital, No. 214, West Section of Pingdu Avenue, Sanhe Town, Fengdu County, Chongqing, 408200, People’s Republic of China, Email whj13364012222@163.com

Purpose: To investigate the relationship between intravenous tirofiban, the number of retrieval attempts and symptomatic intracranial hemorrhage (sICH) in patients with successful EVT.
Patients and Methods: We used the data from the Endovascular Treatment With versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke (RESCUE BT) Trial. The primary outcome was sICH, which was defined according to the Heidelberg Bleeding Classification. The association between the number of retrieval attempts and the rate of sICH was investigated using multivariable logistic regression.
Results: A total of 866 patients were included in our analysis. In overall cohort, tirofiban (OR: 1.853, 95% CI: 1.039– 3.307) and more than 2 passes (3 versus 0– 1: OR: 2.482, 95% CI: 1.124– 5.481; 2 versus 0– 1: OR: 0.813, 95% CI: 0.389– 1.696) were significantly associated with the occurrence of sICH. A significant interaction between the use of tirofiban and the increasing number of attempts was found (p for interaction = 0.02), whereby the presence of sICH was significantly associated with tirofiban (OR: 5.534, 95% CI: 1.586– 19.315) in the subgroup of multiple passes (> 2 passes group), while none was seen in the subgroup of 0– 2 passes. The results of the sensitivity analysis also showed that more than 2 passes (3 versus 1: OR: 2.841, 95% CI: 1.102– 7.323; 2 versus 1: OR: 0.852, 95% CI: 0.346– 2.097) were significantly associated with the occurrence of sICH in the tirofiban group but not in the placebo group.
Conclusion: In patients with multiple attempts, intravenous tirofiban may increase the risk of sICH. Further research and individualized risk assessment are necessary to determine the most appropriate strategy of intravenous tirofiban for EVT patients, especially considering details of thrombectomy procedures.
Registration: : URL: http:// www.chictr.org.cn; Unique identifier: ChiCTR-INR-17014167.

Keywords: tirofiban, hemorrhage, endovascular treatment, stroke