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C87 Tirofiban as a pharmacological strategy for early stabilisation of ica dissection after intracranial thrombectomy: not because i stented, but because i didn’t
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C87 Tirofiban as a pharmacological strategy for early stabilisation of ica dissection after intracranial thrombectomy: not because i stented, but because i didn’t
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Journal Article
C87 Tirofiban as a pharmacological strategy for early stabilisation of ica dissection after intracranial thrombectomy: not because i stented, but because i didn’t
2025
Overview
IntroductionCervical ICA dissection is a dynamic and potentially embolic or haemodynamically significant lesion, and a relevant cause of stroke, especially in young and middle-aged adults. It may present as a tandem lesion. In selected cases, aggressive medical stabilisation after thrombectomy may allow vessel recovery without permanent implants.Abstract C87 Figure 1[Image Omitted. See PDF.]Case DescriptionA 43-year-old man presented with wake-up stroke and right dominant M2 occlusion (NIHSS 18). No IV thrombolysis was given. Under GA, angiography showed a flame-like occlusion of the ICA. Aspiration navigation of the cervical ICA to the siphon was performed using a RED 62 over a J-curved 0.014’ wire and microcatheter, with brief balloon inflation of the FlowGate in the post-bulbar ICA; the FlowGate was then advanced distally, without further inflation. TICI 3 was obtained with one RED 62 pass. After RED removal, the ICA appeared patent but narrowed and irregular. Nimodipine (1 mg) and IV tirofiban were administered. Serial checks over a retained microwire showed improved calibre and smoother wall profile, without thrombus or emboli, so procedure was concluded. Tirofiban was continued until DAPT was started the next morning, after confirming no haemorrhage on brain CT and patency on angio-CT.Abstract C87 Figure 2[Image Omitted. See PDF.]ConclusionsIn dissection-related strokes, tirofiban may offer a temporary, reversible option to stabilise the cervical segment post-thrombectomy. This avoids early stenting risks—malposition, thrombosis, mandatory DAPT—when the dissection is not haemodynamically critical. Here the intracranial occlusion explained the clinical picture, allowing conservative management, as typically adopted in non-embolic dissection, where medical therapy alone often supports vessel healing and long term patency.Abstract C87 Figure 3[Image Omitted. See PDF.]Conflict of InterestNo
Publisher
BMJ Publishing Group LTD
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