Tirofiban for Reduction of Thromboembolic Events in Endovascular Unruptured Aneurysm Repair (TEAR): Rationale and Design of a Randomized Trial DOI Creative Commons

Qianmei Jiang,

Sili Jiang,

Qi Liu

et al.

Research Square (Research Square), Journal Year: 2024, Volume and Issue: unknown

Published: June 13, 2024

Abstract Backgrounds and Objective: New embolic events following stent-assisted coiling (SAC) flow diverting (FD) procedures for unruptured intracranial aneurysms (UIA) pose a significant challenge, the optimal perioperative antithrombotic approach remains inconsistent. This trial aims to investigate efficacy safety of tirofiban in reducing new diffusion-weighted imaging (DWI)-positive ischemic lesions SAC/FD UIA. Hypothesis: Compared standard medical care alone, prophylactic addition can reduce DWI-positive UIA without increasing risk bleeding. Methods: The Tirofiban reduction Thromboembolic Events Endovascular Aneurysm Repair (TEAR) is an investigator-initiated, two-armed (1:1), prospective, randomized, open-label, masked-endpoint, superiority study. A total 192 patients receiving at national stroke center will be recruited randomized into two groups: group—after femoral artery puncture, initial infusion 0.4μg/kg/minute over 30 minutes, followed by continuous 0.1μg/kg/minute 24 hours. Meanwhile, routine dual antiplatelet therapy administered. Control group—routine therapy. 3-T thin-slice (2mm) MRI, including diffusion weighted imaging, arranged all participants within 48 hours after interventional Outcomes: The primary outcome number volume on postoperative DWI procedure. secondary outcomes include any strokes, stroke, transient attack 48-hour 30-day, disabling 30-day. moderate severe bleeding events, according GUSTO (Global Utilization Streptokinase Tissue Plasminogen Activator Occluded Coronary Arteries) criteria, postoperative. Discussion: TEAR-trial first controlled provide evidence-based recommendations triple (routine combined with tirofiban) who underwent SAC FD. Trial registration: NCT06238115.

Language: Английский

Clinical management of a ruptured intracranial aneurysm DOI Creative Commons
Leonidas Trakolis, Athanasios K. Petridis

Frontiers in Stroke, Journal Year: 2024, Volume and Issue: 3

Published: Sept. 24, 2024

Background Intracranial hemorrhage due to a ruptured aneurysm is one of the most serious neurosurgical emergencies. The patient mostly presents with severe headaches and neurological deterioration. A rapid diagnosis an interdisciplinary approach play major role in fate these patients. treatment can vary from endovascular surgical must be carefully individually planned. Neurovascular expertise are vital importance obligatory for best possible outcome. Methods In this narrative review, we scrutinize current literature discuss actual data guidelines order emphasize patients intracranial aneurysm. Results inhomogeneous often ineffective internal disputes between different disciplines. Although there plenty hard evidence “show way,” many still choose base their decisions on personal experience or opinion. Conclusions Every brain should approached manor treated according guidelines.

Language: Английский

Citations

0
Tirofiban for Reduction of Thromboembolic Events in Endovascular Unruptured Aneurysm Repair (TEAR): Rationale and Design of a Randomized Trial DOI Creative Commons

Qianmei Jiang,

Sili Jiang,

Qi Liu

et al.

Research Square (Research Square), Journal Year: 2024, Volume and Issue: unknown

Published: June 13, 2024

Abstract Backgrounds and Objective: New embolic events following stent-assisted coiling (SAC) flow diverting (FD) procedures for unruptured intracranial aneurysms (UIA) pose a significant challenge, the optimal perioperative antithrombotic approach remains inconsistent. This trial aims to investigate efficacy safety of tirofiban in reducing new diffusion-weighted imaging (DWI)-positive ischemic lesions SAC/FD UIA. Hypothesis: Compared standard medical care alone, prophylactic addition can reduce DWI-positive UIA without increasing risk bleeding. Methods: The Tirofiban reduction Thromboembolic Events Endovascular Aneurysm Repair (TEAR) is an investigator-initiated, two-armed (1:1), prospective, randomized, open-label, masked-endpoint, superiority study. A total 192 patients receiving at national stroke center will be recruited randomized into two groups: group—after femoral artery puncture, initial infusion 0.4μg/kg/minute over 30 minutes, followed by continuous 0.1μg/kg/minute 24 hours. Meanwhile, routine dual antiplatelet therapy administered. Control group—routine therapy. 3-T thin-slice (2mm) MRI, including diffusion weighted imaging, arranged all participants within 48 hours after interventional Outcomes: The primary outcome number volume on postoperative DWI procedure. secondary outcomes include any strokes, stroke, transient attack 48-hour 30-day, disabling 30-day. moderate severe bleeding events, according GUSTO (Global Utilization Streptokinase Tissue Plasminogen Activator Occluded Coronary Arteries) criteria, postoperative. Discussion: TEAR-trial first controlled provide evidence-based recommendations triple (routine combined with tirofiban) who underwent SAC FD. Trial registration: NCT06238115.

Language: Английский

Citations

0