Endovascular treatment combined with eptifibatide in patients with acute ischemic stroke: a prospective, multicenter study

Abstract

Objective To explore the efficacy and safety of endovascular treatment (EVT)combined with eptifibatide in the treatment of acute ischemic stroke. Methods This study enrolled the102 acute ischemic stroke patients at 15 centers in China received EVT combined with eptifibatide fromApril 2019 to March 2020. The primary efficacy outcome was the reperfusion rate of blood vessels within24 h after treatment [modified Thrombolysis in Cerebral Infarction (mTICI) grade ≥ 2b], while the secondaryefficacy outcomes were the complete reperfusion (mTICI grade 3) rate of blood vessels within 24 h aftertreatment and the 3⁃month neurological function prognosis [modified Rankin Scale (mRS) score ≤ 2]; theincidence of symptomatic intracranial hemorrhage (sICH) within 48 h after treatment was the primary safetyoutcome, while the incidence of intracranial hemorrhage (ICH), parenchymal hemorrhage (PH), hemorrhagic infarction (HI), remote parenchymal hemorrhage (rPH), intraventricular hemorrhage (IVH), and subarachnoidhemorrhage (SAH) within 48 h, and 3 ⁃ month mortality after treatment were secondary safety outcomes.Univariate and multivariate stepwise Logistic regression analyses were used to screen for the influencingfactors of prognosis after EVT combined with eptifibatide for acute ischemic stroke. Results Thesuccessful reperfusion (mTICI grade ≥ 2b) rate and complete reperfusion (mTICI grade 3) rate of bloodvessels within 24 h after treatment were 86.27% (88/102) and 68.63% (70/102), respectively. The goodprognosis (mRS score ≤ 2) rate at 3⁃month after treatment was 54.90% (56/102). The incidence of sICHwithin 48 h after treatment was 4.90% (5/102). The incidence of ICH was 19.61% (20/102), PH was11.76% (12/102), HI was 5.88% (6/102), rPH was 1.96% (2/102), IVH was 3.92% (4/102), and there wasno SAH within 48 h after treatment. The mortality rate at 3⁃month after treatment was 16.67% (17/102).Logistic regression analysis showed that an admission National Institutes of Health Stroke Scale (NIHSS)score of > 15 was a risk factor for poor prognosis in patients with acute ischemic stroke after EVT combinedwith eptifibatide (OR = 0.118, 95%CI: 0.046-0.307; P = 0.000), while an Alberta Stroke Program Early CTScore (ASPECTS) of ≥ 6 was a protective factor for good prognosis (OR = 5.871, 95%CI: 1.812-19.020; P =0.003). Conclusions The combined regimen of eptifibatide and EVT studied in this trial was effectiveand safe. Optimal administration method and randomized controlled trial are need to be further justified.

doi：10.3969/j.issn.1672⁃6731.2024.11.007