Effect of intravenous tirofiban on the efficacy and safety of stent retriever versus aspiration first-line thrombectomy: secondary analysis of the RESCUE BT trial
Bibliographic record
Abstract
BACKGROUND: Tirofiban is increasingly used as an adjuvant medication during endovascular thrombectomy (EVT) in acute ischemic stroke. We investigated the influence of intravenous tirofiban versus placebo on the clinical outcomes of first-line thrombectomy strategies. METHODS: This secondary analysis of the RESCUE BT (The Endovascular Treatment With Versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke) trial included patients who underwent EVT with a stent retriever (with or without aspiration) or aspiration thrombectomy technique as the first-line strategy. We compared clinical and safety outcomes between stent retrievers and aspiration thrombectomy as first-line EVT strategy and evaluated the interactions with intravenous tirofiban. The primary outcome was the modified Rankin Scale (mRS) score at 90 days follow-up, analyzed using ordinal regression for a shift toward better outcome. Secondary outcomes included angiographic outcomes and symptomatic intracranial hemorrhage (sICH) within 48 hours and 90-day mortality. Multivariable regression analyses with interaction terms were performed. RESULTS: Among the 830 included patients, 464 (55.9%) were treated with a stent retriever as first-line strategy, including 212 (45.7%) patients in tirofiban group. There was no difference in the distribution of mRS score between stent retriever versus aspiration groups [adjusted common odds ratio (acOR) 1.26 (95% CI, 0.99-1.61), P = 0.07], and tirofiban did not improved outcome compared to placebo [acOR, 1.07 (95% CI, 0.84-1.37), P = 0.56]. Intravenous tirofiban may potentially enhance the efficacy of first-line stent retriever thrombectomy by increasing the rates of complete reperfusion [aOR, 1.43 (95% CI, 0.98-2.08), P = 0.06] and first-pass effect [aOR, 1.45 (95% CI, 0.97-2.18), P = 0.07], whereas intravenous tirofiban may potentially enhance the risk of sICH [aOR, 2.10 (95% CI, 0.93-4.43), P = 0.08] in first-line aspiration thrombectomy. No significant interaction between intravenous tirofiban and first-line EVT strategy was found for the clinical and safety outcomes. CONCLUSIONS: In RESCUE BT trial, the treatment effect of perioperative intravenous tirofiban was not influenced by the first-line EVT strategy. In both first-line stent retriever thrombectomy and aspiration thrombectomy groups, we observed no significant differences in the clinical outcomes with the adjunctive use of intravenous tirofiban. Randomized controlled trials are needed to confirm these findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.006 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".