Safety and efficacy of tirofiban in the endovascular treatment of intracranial aneurysms: a systematic evaluation and meta-analysis

Abstract

Patients with intracranial aneurysms (IA) undergoing endovascular treatment face varying risks and benefits when tirofiban is used for thromboprophylaxis during surgery. Currently, there is a lack of high-level evidence summarizing this information. This study aims to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of tirofiban during endovascular treatment of IA. Relevant studies published before November 2024 were searched in the PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials databases. The primary outcomes were intracranial hemorrhage (ICH), thrombosis, and thrombolysis. Secondary outcomes included any non-ICH bleeding events (NoICH-BE), ischemic stroke (IS), intraoperative rupture aneurysm(IRA), follow-up prognosis, and Raymond and Roy classification (RROC). Meta-analysis was performed using Revman 5.3 and StataMP 64 to assess efficacy (thrombosis, IS, thrombolysis) and safety (ICH, NoICH-BE, IRA). A total of 33 studies involving 3,617 IA patients were included. The meta-analysis showed that after the use of tirofiban, the pooled risk (PR) for ICH was 2% ([95% CI, 1-3%]; P < 0.001), for NoICH-BE was 0% ([95% CI, 0-2%]; P > 0.05), for IRA was 2% ([95% CI, 1-3%]; P < 0.001), for thrombosis was 3% ([95% CI, 2-4%]; P < 0.001), for IS was 2% ([95% CI, 0-3%]; P < 0.001), for thrombolysis was 96% ([95% CI, 91-99%]; P < 0.001), for good prognosis (mRS 0-2) was 91% ([95% CI, 85-95%]; P < 0.001), and for RROC 1-2 was 93% ([95% CI, 90-96%]; P < 0.001). This systematic review and meta-analysis demonstrate that the use of tirofiban during endovascular treatment of IA is both feasible and safe.

Keywords: Endovascular treatment; Intracranial aneurysms; Intracranial hemorrhage; Thrombosis; Tirofiban.