Clinical Trial to Evaluate the Safety of Continuous IV Tirofiban in Acute Ischemic Stroke (iTREMT)

This is an interventional treatment trial for Acute Ischemic Stroke focused on measuring Mechanical Thrombectomy, Tirofiban, Distal Vessel Reperfusion Read More

Inclusion Criteria:

• Age ≥ 18 and ≤ 90 years
• Acute ischemic stroke (AIS)
• Onset of AIS 6-24 hrs.
• NIHSS score ≥ 6
• AIS due to LVO
• core infarct <30cc or ASPECT score > 6.
• Received MT per SOC
• TICI score of 2B, or TC post MT.
• Able to be imaged by MRI
• Patient or their Legally Authorized Representative (LAR) has provided written informed consent.

Exclusion Criteria:

• Known allergy or hypersensitivity to tirofiban
• Previous stroke in the past 90 days
• Previous intracranial hemorrhage, neoplasm, subarachnoid hemorrhage, or arterial venous malformation
• Clinical presentation suggested a subarachnoid hemorrhage, even if initial CT scan was normal
• Surgery or biopsy of parenchymal organ in the past 30 days
• Trauma with internal injuries or ulcerative wounds in the past 30 days
• Severe head trauma in the past 90 days
• Systolic blood pressure persistently >180mmHg post-MT despite antihypertensive intervention.
• Diastolic blood pressure persistently >105mmHg post-MT despite antihypertensive intervention.
• Serious systemic hemorrhage in the past 30 days.
• Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency, or oral anticoagulant therapy with INR >1.5
• Positive urine pregnancy test for women of childbearing potential
• Glucose <50 or >400 mg/dl
• Platelets <100,000/mm3
• Hematocrit <25 %
• Elevated PTT above laboratory upper limit of normal
• Creatinine > 4 mg/dl
• Ongoing renal dialysis, regardless of creatinine
• Received Low Molecular Weight heparins (such as Dalteparin, Enoxaparin, Tinzaparin) in full dose within the previous 24 hours
• Abnormal PTT within 48 hours prior to randomization after receiving heparin or a direct thrombin inhibitor (such as bivalirudin, argatroban, dabigatran or lepirudin)
• Received Factor Xa inhibitors (such as Fondaparinux, apixaban or rivaroxaban) within the past 48 hours
• Received iv tPA
• Pre-existing neurological or psychiatric disease which confounded the neurological or functional evaluations e.g., baseline modified Rankin score >3
• Other serious, advanced, or terminal illness or any other condition that the investigator felt would pose a significant hazard to the patient if tirofiban therapy was initiated a. Example: known cirrhosis or clinically significant hepatic disease
• Current participation in another research drug treatment or interventional device trial
• Informed consent from the patient or the legally authorized representative was not or could not be obtained
• High density lesion consistent with hemorrhage of any degree
• ASPECT score < 6
• Deployment of a stent INTRA and/or EXTRA-cranial
• Did not receive MT
• TICI score of 3 post MT
• Extravasation of contrast during procedure
• Perforation of any vessel during procedure.
• Renal dysfunction
• History of gastrointestinal hemorrhage or major systemic hemorrhage within 30 days, hemoglobin less than 8 g/dL on admission, INR ≥1.5, severe liver impairment as defined as AST, ALT, AP, GGT > 2 x normal
• Creatinine clearance <30 mL/min.
• Major surgery within 30 days with contra-indication to antiplatelet therapy
• Currently pregnant.
• Contraindication for MRI

• Contra-indication to antiplatelet tirofiban:

  1. Active internal bleeding or a history of bleeding diathesis within the previous 30 days
  2. History of thrombocytopenia following prior exposure to AGGRASTAT
  3. History, symptoms, or findings suggestive of aortic dissection
  4. Acute pericarditis
• Actual Body Weight >150kg (due to the lack of safety data)