Supplementary Material for: Association of Intravenous Tirofiban with Functional Outcomes in Acute Ischemic Stroke Patients with Acute Basilar Artery Occlusion Receiving Endovascular Thrombectomy

Introduction: The aim of this study was to test the hypothesis that intravenous tirofiban improves functional outcomes without promoting the risk of intracranial hemorrhage (ICH) in stroke secondary to basilar artery occlusion (BAO) receiving endovascular thrombectomy. Methods: Patients with acute BAO stroke who were treated with endovascular thrombectomy and had tirofiban treatment information were derived from “BASILAR”: a nationwide, prospective registry. All eligible patients were divided into tirofiban and no-tirofiban groups according to whether tirofiban was used intravenously. The primary endpoint was the 90-day severity of disability as assessed by the modified Rankin scale score. Safety outcomes were the frequency of ICH and mortality. Results: Of 645 patients included in this cohort, 363 were in the tirofiban group and 282 were in the no-tirofiban group. Thrombectomy with intravenous tirofiban reduced the 90-day disability level over the range of the modified Rankin scale (adjusted common odds ratio, 2.08; 95% confidence interval (CI), 1.45–2.97; p < 0.001). The 90-day mortality of patients in the tirofiban group was lower than that in the no-tirofiban group (41.6% vs. 52.1%; adjusted hazard ratio, 0.60; 95% CI, 0.47–0.77; p < 0.001). The frequency of any ICH (6.7% vs. 13.7%; p = 0.004) and symptomatic ICH (4.8% vs. 10.1%; p = 0.01) in the tirofiban group was significantly lower than that in the no-tirofiban group. Conclusions: In patients with acute BAO stroke who underwent endovascular treatment, intravenous tirofiban might be associated with favorable outcome, reduced mortality, and a decreased frequency of ICH.

研究背景与目的：本研究旨在验证下述假说：对于接受血管内取栓术（endovascular thrombectomy）的基底动脉闭塞（basilar artery occlusion, BAO）相关性卒中患者，静脉应用替罗非班可改善其功能预后，且不会增加颅内出血（intracranial hemorrhage, ICH）风险。研究方法：本研究数据来源于全国性前瞻性登记研究「BASILAR」，纳入对象为接受血管内取栓术且具备替罗非班治疗信息的急性BAO卒中患者。根据是否静脉给予替罗非班，将所有符合入组标准的患者分为替罗非班组与非替罗非班组。本研究的主要终点为采用改良Rankin量表（modified Rankin scale）评分评估的90天残疾严重程度；安全性终点为颅内出血发生频率与死亡率。研究结果：本队列共纳入645例患者，其中替罗非班组363例，非替罗非班组282例。相较于非替罗非班组，联合静脉替罗非班的血管内取栓术可降低患者90天改良Rankin量表评分对应的残疾程度（校正后通用比值比为2.08；95%置信区间（confidence interval, CI）：1.45~2.97；P<0.001）。替罗非班组患者90天死亡率显著低于非替罗非班组（41.6% vs 52.1%；校正后风险比为0.60；95%CI：0.47~0.77；P<0.001）。此外，替罗非班组任何类型颅内出血发生率（6.7% vs 13.7%；P=0.004）及症状性颅内出血发生率（4.8% vs 10.1%；P=0.01）均显著低于非替罗非班组。研究结论：对于接受血管内治疗的急性BAO卒中患者，静脉应用替罗非班或可带来更佳的功能预后，降低死亡率，并减少颅内出血发生风险。