Perforating artery territorial infarction (PAI) refers to a single ischemic lesion in a single perforating arterial territory and branch atheromatous disease (BAD) is an important type. BAD related stroke accounts for 10%-15% ischemic cerebral infarction and is closely related to early neurological deterioration (END). Among patients with single ischemic lesion in other study, dual antiplatelet (clopidogrel plus aspirin) did not significantly reduce the risk of recurrent stroke. The primary purpose of this study is to assess the efficacy and safety of tirofiban combined with aspirin versus placebo combined with aspirin in reducing the risk of stroke and END in patients with BAD.
Branch atheromatous disease (BAD) was characterized by cerebral infarction within penetrating artery territories. It arises from atherosclerotic stenosis or occlusion at the origin or proximal segment of these arteries, with three principal pathological manifestations. BAD is the typical etiology of the isolated infarction in penetrating artery territories. There is still no consensus on the classification, and both the TOAST and the CISS (Chinese ischemic stroke subclassification) have the limitations. Currently, there are no evidence-supported, guideline-based on how to prevent the END of BAD. Combining the pathology of atherosclerosis, we hypothesize that short-term use of tirofiban with aspirin for intensive antiplatelet therapy may confer benefits. The primary purpose of this study is to assess the efficacy and safety of tirofiban combined with aspirin versus placebo combined with aspirin in reducing END and stroke at 90 days in patients with BAD. This is a prospective, randomized, multicenter, double-blind clinical trial. In China, 970 patients with the following criteria will be enrolled: single acute infarction of penetrating artery territory (maximum diameter \<30 mm on DWI of MRI) within 48 hours, which involves two or more transverse layers, or whose maximum diameter ≥15 mm, , or connected to the ventral surface of the median pons without crossing the midline on DWI image, no severe stenosis (defined as \<70%) of parent artery. Patients will be randomly assigned into 2 groups: 1. Tirofiban + Aspirin (Day 1-90) 2. Placebo + Aspirin (Day 1-90) Interviews will be made on baseline, 24 hours after randomization, day 7 after randomization, discharge day, and day 90 after randomization.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
970
Day 1: Tirofiban will be given by bolus injection at 0.4ug/kg/min for the first 30 minutes, followed by a continuous infusion at 0.1ug/kg/min for the next 24 hours.
Day 1: Tirofiban placebo will be injected at the same rate with experimental group.
Day 1: Aspirin 100-300mg per day Day 2-90: Aspirin 100mg per day
The First Hospital of Fangshan District Beijing
Beijing, Beijing Municipality, China
School of Medicine, Xiamen University
Zhangzhou, Fujian, China
Guizhou Provincial People's Hospital
Guiyang, Guizhou, China
Hejian People's Hospital
Hejian, Hebei, China
Tangshan Gongren Hospital
Tangshan, Hebei, China
new stroke or END(early neurological deterioration)
1. Symptoms and signs of acute neurological deficits caused by sudden focal or whole brain, spinal cord, or retinal vascular damage, which are related to cerebral circulatory disorders, including hemorrhagic and ischemic stroke. 2. NIHSS score increasing by ≥ 2 points, or the score increasing by≥1 in either the motor or consciousness level within 7 days after randomization and intracranial hemorrhage is excepted by CT or MRI. Exacerbations not attributable to stroke are also excluded such as cardiac failure, liver and renal failure, etc.
Time frame: 90 days after randomization
new stroke or END
1)Symptoms and signs of acute neurological deficits caused by sudden focal or whole brain, spinal cord, or retinal vascular damage, which are related to cerebral circulatory disorders, including hemorrhagic and ischemic stroke. 2)NIHSS score increasing by ≥ 2 points, or the score increasing by≥1 in either the motor or consciousness level within 7 days after randomization and intracranial hemorrhage is excepted by CT or MRI. Exacerbations not attributable to stroke are also excluded such as cardiac failure, liver and renal failure, etc.
Time frame: 24 hours and 7 days after randomization
Composite vascular events
Symptomatic stroke, myocardial infarction and vascular death.
Time frame: 90 days after randomization
Disability or death
The modified Rankin Scale (mRS) is 2-6 points.
Time frame: 90 days after randomization
Improvement of neurological function
decrease of NIHSS score by ≥4 points or NIHSS score of 0-1 point
Time frame: 24 hours, 7 days, and 90 days after randomization
EQ-5D-5L Scale
It describes the state of health.
Time frame: 90 days after randomization
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The People's Hospital of Qinghe County
Xingtai, Hebei, China
Mengzhou People's Hospital
Henan, Henan, China
Xiuwu People's Hospital
Jiaozuo, Henan, China
Jiyuan Hospital of Traditional Chinese Medicine
Jiyuan, Henan, China
The Second Affiliated Hospital of Henan University of Science and Technology
Luoyang, Henan, China
...and 27 more locations