RESCUE BT Trial: Intravenous Tirofiban Before Endovascular Thrombectomy
In patients with acute LVO stroke undergoing thrombectomy within 24 hours, does peri-procedural IV tirofiban improve 90-day functional outcome compared with placebo?
RESCUE BT Investigators (JAMA 2022) · doi:10.1001/jama.2022.12584 · 948 patients
Population
Included
- Age 18 to 80
- Acute ischemic stroke with anterior-circulation intracranial LVO (ICA, M1, or M2)
- NIHSS 4 or greater
- Treatment within 24 hours of last known well
- Pre-stroke mRS 0 to 2
- Acute ischemic stroke presenting within 24 hours of time last known well
- NIHSS score 30 or less (range 0 to 42)
- Alberta Stroke Program Early CT Score (ASPECTS) 6 or more
- Occlusion of the intracranial internal carotid artery, or the first or second segment of the middle cerebral artery (M1 or M2), confirmed by CTA, MRA, or DSA
Excluded
- Active bleeding or high bleeding risk
- Recent major surgery or trauma
- Contraindication to GP IIb/IIIa inhibitors
- Pre-stroke mRS greater than 2
- Presentation beyond 24 hours from last known well
- Dual antiplatelet therapy within 1 week of the index stroke
- Receipt of intravenous thrombolysis after stroke onset
- Additional detailed selection criteria are provided in the eMethods of Supplement 3 (not reproduced in the primary publication main text)
Source: RESCUE BT Investigators (Qiu et al.), JAMA 2022; reg. ChiCTR-IOR-17014167· Retrieved 2026-06-08
Primary Outcome — mRS Ordinal Shift at 90 Days
948 patients; IV tirofiban vs placebo before and during EVT
mRS Ordinal Shift at 90 Days
cOR 1.08
95% CI 0.87 to 1.34 · P = 0.51
mRS 0-1 — Tirofiban
36.3%
mRS 0-1 — Placebo
32.4%
sICH: 9.7% (tirofiban) vs 6.4% (placebo) · Mortality: 18.3% vs 17.3%
Study Arms
- Agent
- Tirofiban (glycoprotein IIb/IIIa inhibitor)
- Dose
- 10 µg/kg IV bolus, then continuous infusion 0.15 µg/kg/min
- Route
- Intravenous
- Frequency
- Bolus within 5 minutes after randomization, then continuous infusion
- Duration
- Up to 24 hours
- Co-interventions
- All patients underwent rapid endovascular thrombectomy. At the 20th hour after study drug, oral aspirin and/or clopidogrel started (dual antiplatelet if angioplasty/stenting, otherwise single); study drug stopped at the 24th hour. IV heparin allowed during thrombectomy; post-procedure SC/LMW heparin for DVT prophylaxis permitted.
Tirofiban arm, n=463. RESCUE BT JAMA 2022 p.544.
- Agent
- Saline placebo (visually identical to tirofiban)
- Dose
- Volume-matched to tirofiban
- Route
- Intravenous
- Frequency
- Bolus within 5 minutes after randomization, then continuous infusion
- Duration
- Up to 24 hours
- Co-interventions
- All patients underwent rapid endovascular thrombectomy. At the 20th hour, oral aspirin and/or clopidogrel started (dual if angioplasty/stenting, otherwise single); study drug stopped at the 24th hour. Rescue tirofiban was available for this arm if antegrade flow could not be maintained after angioplasty/stenting. IV heparin during thrombectomy; post-procedure heparin for DVT prophylaxis permitted.
Placebo arm, n=485. Both arms received thrombectomy; contrast = tirofiban vs placebo. RESCUE BT JAMA 2022 p.544.
Trial Design
Type
- Investigator-initiated randomized double-blind placebo-controlled trial
- IV tirofiban vs placebo before EVT
- Proximal intracranial LVO within 24 hours
- Conducted at 55 hospitals in China
Timeline
Enrolled 2018-2021
N
948
Enrollment
948 patients at 55 hospitals in China. Double-blind placebo-controlled randomized trial. Enrolled 2018 to 2021. Tirofiban: 10 mcg/kg IV bolus then 0.15 mcg/kg/min for 24 hours. Published JAMA 2022.
Bedside Pearl
Do not give peri-procedural IV tirofiban as routine adjunct to thrombectomy. RESCUE BT showed no functional benefit and a significant increase in symptomatic ICH (9.7% vs 6.4%). Reserve GP IIb/IIIa inhibitors for selected indications such as rescue stenting in intracranial atherosclerosis, not for general LVO thrombectomy.
See also