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

Authors

Rasmiranjan Padhi, K Ariharan, Parvathy Giridas, Jagadeesan Dhanasekaran, Virag Shethna, Vaishali Madhariya

Published in

Neurology India. Aug 19, 2026. Epub Aug 19, 2026.

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.

PMID:
42619285
Bibliographic data and abstract were imported from PubMed on 20 Aug 2026.

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