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Tirofiban with Thrombolysis Effective Against Large Vessel Occlusions in Ischemic Stroke: Presented at ESC

By Michael J. Worthington

MANNHEIM-HEIDELBERG, GERMANY -- May 18, 2004 -- Combined intra-arterial thrombolysis and tirofiban appears to be safe and effective for treating large cerebral vessel occlusion in stroke patients, according to the results of an Italian trial reported here May 14^th at the 13^th European Stroke Conference in Mannheim.

Domenico Inzitari, MD, Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy, explained that reperfusion of affected brain tissues in stroke patients is often inhibited by incomplete thrombolysis of occlusions in the major cerebral arteries. He and his colleagues hypothesized that adding a platelet glycoprotein IIb/IIIa inhibitor to thrombolytic therapy might enhance clot lysis and prevent reocclusion.

They enrolled 11 patients with acute stroke who presented with an major cerebral artery occlusion (e.g. carotid, middle cerebral artery, basilar artery) despite being treated for at least 6 hours for anterior stroke or 12 hours for posterior circulation stroke. In addition to urokinase at a mean dose of 802,000 IU, all patients received tirofiban 0.4 mcg/kg/min bolus for 3 minutes followed by infusion of 0.1 mcg/kg/min. Patients also received mechanical maneuvers, such as thromboaspiration and microballoon angioplasty.

According to Dr.. Inzitari, 7 patients achieved a partial artery recanalization (Thrombolysis in Myocardial Infarction grade 0) after the procedure and 4 patients did not. The recanalized patients experienced neurological improvement, whereas 2 of the other patients remained unchanged and 2 worsened.

After 24 hours, artery recanalization was complete in 10 patients and partial in 1. None of the patients had hemorrhagic bleeding and none required blood transfusion. One patient experienced a mild subarachnoid hemorrhage, 2 patients had hematuria, and 1 patient had groin hematoma.

"There was good clinical and functional outcome in these patients compared with the poor prognosis most often seen in patients with major artery occlusions," Dr. Inzitari said. "The majority of patients had complete reopening of the occluded vessels and recanalization occurred progressively in some patients during the 24 hours after the procedure. Importantly, neurological improvement progressed in the 24 hours after vessel reopening."

"These observations seem to be promising, but we have to perform a controlled study," Dr. Inzitari concluded.


[Presentation title: "Combined intra-arterial thrombolysis and tirofiban in major cerebral artery occlusions: Preliminary results."]

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