Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke: The RESCUE BT Randomized Clinical Trial

doi:10.1001/jama.2022.12584

Randomized Controlled Trial

. 2022 Aug 9;328(6):543-553.

doi: 10.1001/jama.2022.12584.

Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke: The RESCUE BT Randomized Clinical Trial

RESCUE BT Trial Investigators; Zhongming Qiu^{1

2}, Fengli Li¹, Hongfei Sang³, Weidong Luo^{1

4}, Shuai Liu¹, Wenhua Liu⁵, Zhangbao Guo⁵, Huagang Li⁶, Dong Sun⁶, Wenguo Huang⁷, Min Zhang⁷, Min Zhang⁸, Weipeng Dai⁸, Peiyang Zhou⁹, Wei Deng⁹, Zhiming Zhou¹⁰, Xianjun Huang¹⁰, Bo Lei¹¹, Jinglun Li¹², Zhengzhou Yuan¹², Bo Song¹³, Jian Miao¹⁴, Shudong Liu¹⁵, Zhenglong Jin¹⁶, Guoyong Zeng¹⁷, Hongliang Zeng¹⁷, Junjie Yuan¹, Changming Wen¹⁸, Yang Yu¹⁸, Guangxiong Yuan¹⁹, Junxiong Wu¹⁹, Chen Long¹⁹, Jun Luo²⁰, Zhenxuan Tian²⁰, Chong Zheng²¹, Zhizhou Hu²¹, Shouchun Wang²², Tao Wang²³, Li Qi²⁴, Rongzong Li²⁴, Yue Wan²⁵, Yingbing Ke²⁵, Youlin Wu²⁶, Xiurong Zhu²⁶, Weilin Kong¹, Jiacheng Huang¹, Daizhou Peng²⁷, Mingze Chang²⁸, Hanming Ge²⁸, Zhonghua Shi²⁹, Zhizhong Yan²⁹, Jie Du³⁰, Ying Jin³¹, Dongsheng Ju³¹, Chuming Huang³², Yifan Hong³², Tianzhu Liu³³, Wenlong Zhao³⁴, Jian Wang³⁵, Bo Zheng³⁵, Li Wang³⁶, Shugai Liu³⁷, Xiaojun Luo³⁷, Shiwei Luo³⁸, Xinwei Xu³⁸, Jinrong Hu¹, Jie Pu^{39

40}, Shengli Chen⁴¹, Yaxuan Sun⁴², Shunfu Jiang⁴³, Liping Wei⁴⁴, Xinmin Fu⁴⁵, Yongjie Bai⁴⁶, Shunyu Yang⁴⁷, Wei Hu⁴⁸, Guling Zhang⁴⁹, Chengde Pan⁵⁰, Shuai Zhang⁵¹, Yan Wang⁵², Wenfeng Cao⁵³, Shiquan Yang⁵⁴, Jun Zhang⁵⁵, Fuqiang Guo⁵⁶, Hongbin Wen⁵⁷, Jinhua Zhang⁵⁸, Jiaxing Song¹, Chengsong Yue¹, Linyu Li¹, Deping Wu¹, Yan Tian¹, Jie Yang¹, Mengjie Lu⁵⁹, Jeffrey L Saver⁶⁰, Raul G Nogueira⁶¹, Wenjie Zi¹, Qingwu Yang^{1

62}

Collaborators, Affiliations

Collaborators

RESCUE BT Trial Investigators:
Jie Shuai, Zili Gong, Li Huang, Juan Liu, Kun Tang, Zhenhui Duan, Houjie Ni, Yumin Liu, Fei Xie, Dongrun Yan, Songsheng Ye, Zhiquan Zhang, Zhihua Cao, Xianjin Shang, Xianhui Ding, Xiangjun Xu, Li Chen, Jiachuan Wu, Renliang Meng, Li Jiang, Yang Xie, Lei Lei, Libo Zhao, Tao Yu, Zhengjin Luo, Bin Li, Ning Wang, Jun Sun, Yong Liang, Zongqin Li, Xuejie Xu, Kangjia Song, Zeyu Hao, Chuanqing Yu, Xiaofei Zhou, Jing Zuo, Wenbin Wu, Xiyang Chen, Yaoyu Tian, Xiaogang Hu, Liang Wei, Xiuhua Wu, De'an Fu, Ce Han, Chunying Li, Yachun Liu, Chukai Xu, Shiyu Deng, Ling Fang, Gangfeng Gu, Rong Su, Jing Guo, Jing Wang, Minghua Cao, Mingchao Wu, Xuxu Wu, Yupeng Wu, Jisheng Qi, Da Liu, Wenkai Long, Yuxian Zhang, Mingshan Tang, Fei Zeng, Changya Liu, Tieyu Tang, Ying Yang, Yongliang Zhou, Dongzhang Xue, Ju Han, Jianhong Wang, Xuan Liu, Xu Zheng, Anding Xu, Guilian Zhang, Dong Yi, Yonggang Hao, Dan Liu, Min Lin, Fajin Lv, Chao Qin, Hua Yang

Affiliations

¹ Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China.
² Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China.
³ Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁴ Department of Cardiovascular diseases, The General Hospital of Tibet Military Area Command, Lhasa, China.
⁵ Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China.
⁶ Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China.
⁷ Department of Neurology, Chinese Medical Hospital of Maoming, Maoming, China.
⁸ Department of Neurology, Jiangmen Central Hospital, Jiangmen, China.
⁹ Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China.
¹⁰ Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China.
¹¹ Department of Cerebrovascular Diseases, Leshan People's Hospital, Leshan, China.
¹² Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
¹³ Department of Neurosurgery, Xianyang Hospital of Yan'an University, Xianyang, China.
¹⁴ Department of Neurology, Xianyang Hospital of Yan'an University, Xianyang, China.
¹⁵ Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan, China.
¹⁶ Department of Neurology, Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China.
¹⁷ Department of Neurology, Ganzhou People's Hospital, Ganzhou, China.
¹⁸ Department of Neurology, Nanyang Central Hospital, Nanyang, China.
¹⁹ Department of Emergency, Xiangtan Central Hospital, Xiangtan, China.
²⁰ Department of Neurology, Sichuan Mianyang 404 Hospital, Mianyang, China.
²¹ Department of Neurology, Longyan First Affliated Hospital of Fujian Medical University, Longyan, China.
²² Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China.
²³ Department of Neurology, Huainan First People's Hospital, Huainan, China.
²⁴ Department of Neurology, The 924th Hospital of The People's Liberation Army, Guilin, China.
²⁵ Department of Neurology, The Third People's Hospital of Hubei Province, Wuhan, China.
²⁶ Department of Neurology, Chongzhou People's Hospital, Chongzhou, China.
²⁷ Department of Neurology, Qianxinan People's Hospital, Xingyi, China.
²⁸ Department of Neurology, Xi'an Third Hospital, Xi'an, China.
²⁹ Department of Neurosurgery, The 904th Hospital of The People's Liberation Army, Wuxi, China.
³⁰ Department of Neurology, Kaizhou District People's Hospital, Kaizhou, China.
³¹ Department of Neurology, Songyuan Jilin Oilfield Hospital, Songyuan, China.
³² Department of Neurology, Shantou Central Hospital, Shantou, China.
³³ Department of Neurology, Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, China.
³⁴ Department of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
³⁵ Department of Neurology, Ya'an People's Hospital, Ya'an, China.
³⁶ Department of Neurology, The Third People's Hospital of Zigong, Zigong, China.
³⁷ Department of Cerebrovascular Diseases, Guangyuan Central Hospital, Guangyuan, China.
³⁸ Department of Neurology, Jieyang People's Hospital, Jieyang, China.
³⁹ Department of Neurology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China.
⁴⁰ Department of Neurology, People's Hospital of Wuhan University, Hubei General Hospital, Wuhan, China.
⁴¹ Department of Neurology, Chongqing University Three Gorges Central Hospital, Wanzhou, China.
⁴² Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China.
⁴³ Department of Neurology, Jingdezhen First People's Hospital, Jingdezhen, China.
⁴⁴ Department of Neurointervention, Luoyang Central Hospital, Luoyang, China.
⁴⁵ Department of Neurology, Xuzhou Central Hospital, Xuzhou, China.
⁴⁶ Department of Neurology, The First Affiliated Hospital of Henan Science and Technology University, Luoyang, China.
⁴⁷ Department of Neurology, The First People's Hospital of Yunnan Province, Kunming, China.
⁴⁸ Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China.
⁴⁹ Department of Neurology, Danzhai County People's Hospital, Danzhai, China.
⁵⁰ Department of Neurology, Banan District People's Hospital, Banan, China.
⁵¹ Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou, China.
⁵² Department of Neurology, The Fifth People's Hospital of Chengdu, Chengdu, China.
⁵³ Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China.
⁵⁴ Department of Neurology, The 902nd Hospital of The People's Liberation Army, Bengbu, China.
⁵⁵ Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.
⁵⁶ Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China.
⁵⁷ Department of Neurology, Xiangyang Central Hospital, Hubei Arts and Science University, Xiangyang, China.
⁵⁸ Department of Neurology, Sir Run Run Shaw Hospital affiliated to Zhejiang University, Hangzhou, China.
⁵⁹ School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China.
⁶⁰ Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California.
⁶¹ Department of Neurology, Marcus Stroke & Neuroscience Centre, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia.
⁶² Chongqing Institute for Brain and Intelligence, Guangyang Bay Laboratory, Chongqing 400064, China.

PMID: 35943471
PMCID: PMC9364124
DOI: 10.1001/jama.2022.12584

Randomized Controlled Trial

Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke: The RESCUE BT Randomized Clinical Trial

RESCUE BT Trial Investigators et al. JAMA. 2022.

. 2022 Aug 9;328(6):543-553.

doi: 10.1001/jama.2022.12584.

Authors

Collaborators

RESCUE BT Trial Investigators:
Jie Shuai, Zili Gong, Li Huang, Juan Liu, Kun Tang, Zhenhui Duan, Houjie Ni, Yumin Liu, Fei Xie, Dongrun Yan, Songsheng Ye, Zhiquan Zhang, Zhihua Cao, Xianjin Shang, Xianhui Ding, Xiangjun Xu, Li Chen, Jiachuan Wu, Renliang Meng, Li Jiang, Yang Xie, Lei Lei, Libo Zhao, Tao Yu, Zhengjin Luo, Bin Li, Ning Wang, Jun Sun, Yong Liang, Zongqin Li, Xuejie Xu, Kangjia Song, Zeyu Hao, Chuanqing Yu, Xiaofei Zhou, Jing Zuo, Wenbin Wu, Xiyang Chen, Yaoyu Tian, Xiaogang Hu, Liang Wei, Xiuhua Wu, De'an Fu, Ce Han, Chunying Li, Yachun Liu, Chukai Xu, Shiyu Deng, Ling Fang, Gangfeng Gu, Rong Su, Jing Guo, Jing Wang, Minghua Cao, Mingchao Wu, Xuxu Wu, Yupeng Wu, Jisheng Qi, Da Liu, Wenkai Long, Yuxian Zhang, Mingshan Tang, Fei Zeng, Changya Liu, Tieyu Tang, Ying Yang, Yongliang Zhou, Dongzhang Xue, Ju Han, Jianhong Wang, Xuan Liu, Xu Zheng, Anding Xu, Guilian Zhang, Dong Yi, Yonggang Hao, Dan Liu, Min Lin, Fajin Lv, Chao Qin, Hua Yang

Affiliations

¹ Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing 400037, China.
² Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China.
³ Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
⁴ Department of Cardiovascular diseases, The General Hospital of Tibet Military Area Command, Lhasa, China.
⁵ Department of Neurology, Wuhan No. 1 Hospital, Wuhan, China.
⁶ Department of Neurology, Zhongnan Hospital, Wuhan University, Wuhan, China.
⁷ Department of Neurology, Chinese Medical Hospital of Maoming, Maoming, China.
⁸ Department of Neurology, Jiangmen Central Hospital, Jiangmen, China.
⁹ Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, China.
¹⁰ Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China.
¹¹ Department of Cerebrovascular Diseases, Leshan People's Hospital, Leshan, China.
¹² Department of Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
¹³ Department of Neurosurgery, Xianyang Hospital of Yan'an University, Xianyang, China.
¹⁴ Department of Neurology, Xianyang Hospital of Yan'an University, Xianyang, China.
¹⁵ Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing Key Laboratory of Cerebrovascular Disease Research, Yongchuan, China.
¹⁶ Department of Neurology, Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China.
¹⁷ Department of Neurology, Ganzhou People's Hospital, Ganzhou, China.
¹⁸ Department of Neurology, Nanyang Central Hospital, Nanyang, China.
¹⁹ Department of Emergency, Xiangtan Central Hospital, Xiangtan, China.
²⁰ Department of Neurology, Sichuan Mianyang 404 Hospital, Mianyang, China.
²¹ Department of Neurology, Longyan First Affliated Hospital of Fujian Medical University, Longyan, China.
²² Department of Neurology, The First Affiliated Hospital of Jilin University, Changchun, China.
²³ Department of Neurology, Huainan First People's Hospital, Huainan, China.
²⁴ Department of Neurology, The 924th Hospital of The People's Liberation Army, Guilin, China.
²⁵ Department of Neurology, The Third People's Hospital of Hubei Province, Wuhan, China.
²⁶ Department of Neurology, Chongzhou People's Hospital, Chongzhou, China.
²⁷ Department of Neurology, Qianxinan People's Hospital, Xingyi, China.
²⁸ Department of Neurology, Xi'an Third Hospital, Xi'an, China.
²⁹ Department of Neurosurgery, The 904th Hospital of The People's Liberation Army, Wuxi, China.
³⁰ Department of Neurology, Kaizhou District People's Hospital, Kaizhou, China.
³¹ Department of Neurology, Songyuan Jilin Oilfield Hospital, Songyuan, China.
³² Department of Neurology, Shantou Central Hospital, Shantou, China.
³³ Department of Neurology, Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University, Luzhou, China.
³⁴ Department of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
³⁵ Department of Neurology, Ya'an People's Hospital, Ya'an, China.
³⁶ Department of Neurology, The Third People's Hospital of Zigong, Zigong, China.
³⁷ Department of Cerebrovascular Diseases, Guangyuan Central Hospital, Guangyuan, China.
³⁸ Department of Neurology, Jieyang People's Hospital, Jieyang, China.
³⁹ Department of Neurology, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China.
⁴⁰ Department of Neurology, People's Hospital of Wuhan University, Hubei General Hospital, Wuhan, China.
⁴¹ Department of Neurology, Chongqing University Three Gorges Central Hospital, Wanzhou, China.
⁴² Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China.
⁴³ Department of Neurology, Jingdezhen First People's Hospital, Jingdezhen, China.
⁴⁴ Department of Neurointervention, Luoyang Central Hospital, Luoyang, China.
⁴⁵ Department of Neurology, Xuzhou Central Hospital, Xuzhou, China.
⁴⁶ Department of Neurology, The First Affiliated Hospital of Henan Science and Technology University, Luoyang, China.
⁴⁷ Department of Neurology, The First People's Hospital of Yunnan Province, Kunming, China.
⁴⁸ Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China.
⁴⁹ Department of Neurology, Danzhai County People's Hospital, Danzhai, China.
⁵⁰ Department of Neurology, Banan District People's Hospital, Banan, China.
⁵¹ Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou, China.
⁵² Department of Neurology, The Fifth People's Hospital of Chengdu, Chengdu, China.
⁵³ Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China.
⁵⁴ Department of Neurology, The 902nd Hospital of The People's Liberation Army, Bengbu, China.
⁵⁵ Department of Neurology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China.
⁵⁶ Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China.
⁵⁷ Department of Neurology, Xiangyang Central Hospital, Hubei Arts and Science University, Xiangyang, China.
⁵⁸ Department of Neurology, Sir Run Run Shaw Hospital affiliated to Zhejiang University, Hangzhou, China.
⁵⁹ School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, China.
⁶⁰ Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California.
⁶¹ Department of Neurology, Marcus Stroke & Neuroscience Centre, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia.
⁶² Chongqing Institute for Brain and Intelligence, Guangyang Bay Laboratory, Chongqing 400064, China.

PMID: 35943471
PMCID: PMC9364124
DOI: 10.1001/jama.2022.12584

Abstract

Importance: Tirofiban is a highly selective nonpeptide antagonist of glycoprotein IIb/IIIa receptor, which reversibly inhibits platelet aggregation. It remains uncertain whether intravenous tirofiban is effective to improve functional outcomes for patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy.

Objective: To assess the efficacy and adverse events of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke secondary to large vessel occlusion.

Design, setting, and participants: This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 55 hospitals in China, enrolling 948 patients with stroke and proximal intracranial large vessel occlusion presenting within 24 hours of time last known well. Recruitment took place between October 10, 2018, and October 31, 2021, with final follow-up on January 15, 2022.

Interventions: Participants received intravenous tirofiban (n = 463) or placebo (n = 485) prior to endovascular thrombectomy.

Main outcomes and measures: The primary outcome was disability level at 90 days as measured by overall distribution of the modified Rankin Scale scores from 0 (no symptoms) to 6 (death). The primary safety outcome was the incidence of symptomatic intracranial hemorrhage within 48 hours.

Results: Among 948 patients randomized (mean age, 67 years; 391 [41.2%] women), 948 (100%) completed the trial. The median (IQR) 90-day modified Rankin Scale score in the tirofiban group vs placebo group was 3 (1-4) vs 3 (1-4). The adjusted common odds ratio for a lower level of disability with tirofiban vs placebo was 1.08 (95% CI, 0.86-1.36). Incidence of symptomatic intracranial hemorrhage was 9.7% in the tirofiban group vs 6.4% in the placebo group (difference, 3.3% [95% CI, -0.2% to 6.8%]).

Conclusions and relevance: Among patients with large vessel occlusion acute ischemic stroke undergoing endovascular thrombectomy, treatment with intravenous tirofiban, compared with placebo, before endovascular therapy resulted in no significant difference in disability severity at 90 days. The findings do not support use of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke.

Trial registration: Chinese Clinical Trial Registry Identifier: ChiCTR-IOR-17014167.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Saver reported receiving contracted hourly payments for service on clinical trial steering committees advising on rigorous trial design and conduct from Medtronic, Cerenovus, NeuroVasc, Boehringer Ingelheim (prevention only); stock options for service on Clinical Trial Steering Committees advising on rigorous trial design and conduct from Rapid Medical; and contracted hourly payments for service on data safety monitoring committee advising on rigorous trial design, safety, and conduct from MIVI outside the submitted work. Dr Nogueira reported receiving consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Philips, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, and Synchron and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse, and Perfuze and being one of the principal investigators of the Endovascular Therapy for Low NIHSS Ischemic Strokes (ENDOLOW) trial (funding for this project is provided by Cerenovus) and being an investor in Viz-AI, Perfuze, Cerebrotech, Reist/Q’Apel Medical, Truvic, Vastrax, and Viseon. No other disclosures were reported.

Figures

**Figure 1.. Flow of Patients in a Study of the Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy**
^aOne participant was excluded for metastatic spread of cancer to the brain, 1 was excluded for receiving tirofiban treatment in another hospital, and 1 was excluded for a history of hyperthyroidism that was determined to preclude endovascular treatment. ^bRandomization was stratified by baseline National Institutes of Health Stroke Scale score (≤17 or >17), occlusion site (the intracranial internal carotid artery or not), and participating center.

**Figure 2.. Distribution of Global Disability at 90 Days Based on the Modified Rankin Scale Score**
Scores on the modified Rankin Scale for patients in the tirofiban group and the placebo group are shown according to randomization. Scores on the modified Rankin Scale of functional disability range from 0 (no symptoms) to 6 (death). The score was evaluated centrally by 2 modified Rankin Scale–certified neurologists who were blinded to treatment randomization and who reviewed the video or voice recordings elicited using a structured assessment.

**Figure 3.. Heterogeneity of Treatment Effect for Less Disability Among Prespecified Subgroups**
The forest plot displays effect variation across 8 prespecified subgroups for the adjusted common odds ratio of less disability at 90 days. A lower modified Rankin Scale (mRS) score indicates less disability. The thresholds for age, baseline National Institutes of Health Stroke Scale score, baseline Alberta Stroke Program Early CT Score (ASPECTS), and onset to randomization time were chosen at the median. MCA-M1 and M2 indicate the first and second segments of the middle cerebral artery, respectively. ^aSalvage therapy was defined as failure of primary means of thrombectomy (eg, stent-retriever or local aspiration) and use of balloon angioplasty and/or stenting. ^bThe outcome presented was defined as the adjusted common odds ratio for a favorable shift to a lower mRS score at 90 days. Adjusted odds ratios are used for the testing of statistical significance.

See this image and copyright information in PMC

Comment in

Therapeutic Strategies for Intracranial Atherosclerosis.
Anderson CS, Song L, Liu J. Anderson CS, et al. JAMA. 2022 Aug 9;328(6):529-531. doi: 10.1001/jama.2022.11525. JAMA. 2022. PMID: 35943482 No abstract available.

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References

1. Saver JL, Goyal M, Bonafe A, et al. ; SWIFT PRIME Investigators . Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285-2295. doi:10.1056/NEJMoa1415061 - DOI - PubMed
1. Nogueira RG, Jadhav AP, Haussen DC, et al. ; DAWN Trial Investigators . Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11-21. doi:10.1056/NEJMoa1706442 - DOI - PubMed
1. Berkhemer OA, Fransen PS, Beumer D, et al. ; MR CLEAN Investigators . A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11-20. doi:10.1056/NEJMoa1411587 - DOI - PubMed
1. Albers GW, Marks MP, Kemp S, et al. ; DEFUSE 3 Investigators . Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708-718. doi:10.1056/NEJMoa1713973 - DOI - PMC - PubMed
1. Goyal M, Menon BK, van Zwam WH, et al. ; HERMES collaborators . Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-1731. doi:10.1016/S0140-6736(16)00163-X - DOI - PubMed

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[1] Saver JL, Goyal M, Bonafe A, et al. ; SWIFT PRIME Investigators . Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285-2295. doi:10.1056/NEJMoa1415061 - DOI - PubMed

[2] Saver JL, Goyal M, Bonafe A, et al. ; SWIFT PRIME Investigators . Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285-2295. doi:10.1056/NEJMoa1415061 - DOI - PubMed

[3] Nogueira RG, Jadhav AP, Haussen DC, et al. ; DAWN Trial Investigators . Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11-21. doi:10.1056/NEJMoa1706442 - DOI - PubMed

[4] Nogueira RG, Jadhav AP, Haussen DC, et al. ; DAWN Trial Investigators . Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11-21. doi:10.1056/NEJMoa1706442 - DOI - PubMed

[5] Berkhemer OA, Fransen PS, Beumer D, et al. ; MR CLEAN Investigators . A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11-20. doi:10.1056/NEJMoa1411587 - DOI - PubMed

[6] Berkhemer OA, Fransen PS, Beumer D, et al. ; MR CLEAN Investigators . A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11-20. doi:10.1056/NEJMoa1411587 - DOI - PubMed

[7] Albers GW, Marks MP, Kemp S, et al. ; DEFUSE 3 Investigators . Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708-718. doi:10.1056/NEJMoa1713973 - DOI - PMC - PubMed

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Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke: The RESCUE BT Randomized Clinical Trial

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Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke: The RESCUE BT Randomized Clinical Trial

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