Rescue Stenting in Refractory Middle Cerebral Artery Thrombectomy Using Drug-Eluting Stent with Short-Duration Tirofiban Infusion

Abstract

Intracranial atherosclerotic disease (ICAD) is an essential cause of failed first-pass mechanical thrombectomy (MT) requiring rescue techniques. Rescue intracranial stenting (RIS) is a successful technique for repeated recanalization failure during MT; however, optimal antithrombotic management to maintain stent patency while mitigating bleeding risk remains an area of research. In this report, we propose a short-duration tirofiban infusion protocol for RIS with more than one year of stent patency follow-up. We performed a retrospective case series study of ten patients who underwent RIS after failed revascularization attempts in middle cerebral artery occlusion due to ICAD and were treated with intra-arterial tirofiban bolus, followed by dual antiplatelet loading and intravenous tirofiban infusion for four hours. We analyzed recanalization rate, 90-day functional outcome, symptomatic hemorrhage, and long-term stented-artery patency. Successful reperfusion (mTICI 2b–3) was achieved in all patients. At 90 days, eight patients achieved a favorable functional outcome (modified Rankin Scale 0–2), with a median mRS of 0 (range 0–6). One patient experienced a symptomatic intracranial hemorrhage. One patient died during follow-up. Clinical or angiographic follow-up beyond one year was available for nine patients; among the five patients who underwent conventional angiographic, four demonstrated no in-stent restenosis, while one developed severe (>70%) restenosis at two-year follow-up. In this descriptive case series of ten patients, a short-duration tirofiban infusion protocol following RIS was feasible and was not associated with a high rate of hemorrhagic complications. These observations are hypothesis-generating and require validation in larger, controlled cohorts.