Efficacy and Safety of Tirofiban in Acute Ischemic Stroke Due to Intracranial Atherosclerotic Disease: A Systematic Review and Meta-analysis

Introduction: Intracranial Atherosclerotic Disease (ICAD) accounts for over 100,000 strokes annually only in the United States. Tirofiban has emerged as an adjunct to Acute Ischemic Stroke (AIS) endovascular treatment (EVT). However, its benefits for ICAD-related AIS remains unclear. This meta-analysis evaluates the efficacy and safety of adjunct Tirofiban in ICAD-related AIS patients undergoing EVT.

Methods: We searched PubMed, Cochrane, and Embase databases until September, 26th 2024, including studies comparing Tirofiban to placebo or no intervention in ICAD-related AIS. The primary outcome was the modified Rankin Scale (mRS) 0-2 at 90 days. Secondary outcomes included mRS score in 90 days, successful reperfusion, 90-day mortality, postprocedural reocclusion, symptomatic and any intracranial hemorrhage (ICH). R software, version 4.4.0, was used for risk ratio (RR), and mean difference (MD), in a random-effect model. Subgroup analysis was performed based on the administration route (intravenous, intra-arterial or combined).

Results: 13 studies, comprising 3572 patients, were included. Intravenous Tirofiban was associated with a statistically higher incidence of mRS 0-2 at 90 days (RR 1.26 [CI 95% 1.13; 1.42]; p< 0.0001, I²= 0%), a significant reduction of 0.58 points in 90-day mRS score ([CI 95% -0.99; -0.17]; p=0.006, I²= 66%) and lower 90-day mortality (RR 0.68 [CI 95% 0.57; 0.80]; p< 0.0001, I²= 8%) compared to control. An overall analysis demonstrated that Tirofiban statistically decrease postprocedural reocclusion in comparison to control (RR 0.36 [CI 95% 0.14; 0.94]; p=0.0367, I²= 73%). No statistical difference was observed in successful reperfusion, or ICH between groups.

Conclusion : Intravenous Tirofiban improved functional recovery and reduced 90-day mortality compared to the control group, while the overall analysis, considering all routes of administration, showed a reduction in postprocedural reocclusion rates, compared to control. Additionally, there were no significant differences in terms of successful reperfusion or intracranial hemorrhage between groups.