{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:57:45Z","timestamp":1786125465133,"version":"build-2736575974"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2020,5,16]],"date-time":"2020-05-16T00:00:00Z","timestamp":1589587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2020,11]]},"abstract":"Abstract<\/jats:title>\n \n BACKGROUND<\/jats:title>\n There has not been any effective prophylaxis for delayed cerebral ischemia delayed cerebral ischemia (DCI) since the introduction of nimodipine. Platelet inhibition may reduce the risk by preventing the formation of microthrombi. Tirofiban has been used as a single monotherapy bridge given its safety profile and controlled platelet inhibition.<\/jats:p>\n <\/jats:sec>\n \n OBJECTIVE<\/jats:title>\n To assess the risk of DCI in aneurysmal subarachnoid hemorrhages (aSAH) patients treated with the tirofiban protocol.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n aSAH patients between December 2010 and March 2019 who were treated with stent assisted coiling or flow-diverting device were started on a continuous tirofiban infusion protocol and were compared with patients who underwent coil embolization without antiplatelet therapy. Safety analysis was performed to assess DCI, hemorrhagic, and ischemic events.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n \n A total of 21 patients were included in the tirofiban series and 81 in the control group. There was no statistical difference in age, gender, Hunt-Hess grade, and Fisher scale between the 2 groups except for a higher Fisher grade II in the tirofiban group. Multivariate analysis revealed tirofiban to reduce the risk of vasospasm by 72 percent (OR .28,\n P<\/jats:italic>\n \u00a0=\u00a0.03), without affecting the risk of hemorrhagic complications (OR\u00a0=\u00a00.50,\n P<\/jats:italic>\n \u00a0=\u00a0.26). Tirofiban reduced the risk of symptomatic stroke endovascular procedure but it did not reach significance (\n P<\/jats:italic>\n \u00a0=\u00a0.06). DCI, older age, and postprocedural symptomatic stroke were significant predictors of mortality. Tirofiban reduced the mortality risk, but this association was not statistically significant.\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n The tirofiban protocol in aSAH patients reduces the risk of DCI without conferring additional risks. This supports previous findings were antiplatelet therapy reduced DCI in human and animal models.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/neuros\/nyaa170","type":"journal-article","created":{"date-parts":[[2020,4,14]],"date-time":"2020-04-14T23:29:06Z","timestamp":1586906946000},"page":"E552-E556","source":"Crossref","is-referenced-by-count":15,"title":["Tirofiban Protocol Protects Against Delayed Cerebral Ischemia: A Case-Series Study"],"prefix":"10.1227","volume":"87","author":[{"given":"Mario","family":"Zanaty","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Osorno-Cruz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Byer","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge A","family":"Roa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"},{"name":"Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaustubh","family":"Limaye","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daizo","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daichi","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"},{"name":"Department of Neurosurgery, University of Tokyo, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Torner","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Yongjun","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Ortega-Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar A","family":"Samaniego","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Allan","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tokyo, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,11]]},"reference":[{"issue":"2","key":"bib1-20231011","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.nec.2009.10.014","article-title":"Outcome and cost of aneurysmal subarachnoid hemorrhage","volume":"21","author":"le Roux","year":"2010","journal-title":"Neurosurg Clin N Am"},{"issue":"3","key":"bib2-20231011","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1056\/NEJMra052732","article-title":"Aneurysmal subarachnoid hemorrhage","volume":"354","author":"Suarez","year":"2006","journal-title":"N Engl J Med"},{"issue":"5","key":"bib3-20231011","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.wneu.2011.02.030","article-title":"Vasospasm after aneurysmal subarachnoid hemorrhage: review of randomized controlled trials and meta-analyses in the literature","volume":"76","author":"Velat","year":"2011","journal-title":"World Neurosurg"},{"issue":"4","key":"bib4-20231011","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1161\/01.STR.16.4.562","article-title":"Cerebral vasospasm following aneurysmal subarachnoid hemorrhage","volume":"16","author":"Kassell","year":"1985","journal-title":"Stroke"},{"issue":"1","key":"bib5-20231011","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/0967-5868(94)90005-1","article-title":"A review of cerebral vasospasm in aneurysmal subarachnoid haemorrhage part I: incidence and effects","volume":"1","author":"Dorsch","year":"1994","journal-title":"J Clin Neurosci"},{"issue":"1","key":"bib6-20231011","first-page":"21","article-title":"Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale","volume":"59","author":"Frontera","year":"2006","journal-title":"Neurosurgery"},{"issue":"3","key":"bib7-20231011","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1093\/bja\/aes264","article-title":"Delayed cerebral ischaemia after subarachnoid haemorrhage: looking beyond vasospasm","volume":"109","author":"Rowland","year":"2012","journal-title":"Br J Anaesth"},{"key":"bib8-20231011","first-page":"301","article-title":"Apoplexy in the hippocratic writings","volume":"37","author":"Clarke","year":"1963","journal-title":"Bull Hist Med"},{"key":"bib9-20231011","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1056\/NEJM189111051251901","article-title":"Relations between arterial disease and visceral changes","volume":"125","author":"Peabody","year":"1891","journal-title":"Boston Med Surg J"},{"issue":"11","key":"bib10-20231011","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1056\/NEJM198303173081103","article-title":"Cerebral arterial spasm-a controlled trial of nimodipine in patients with subarachnoid hemorrhage","volume":"308","author":"Allen","year":"1983","journal-title":"N Engl J Med"},{"issue":"3-4","key":"bib11-20231011","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1007\/BF01456369","article-title":"Prevention of vasospasm in subarachnoid haemorrhage. A controlled study with nimodipine","volume":"82","author":"Philippon","year":"1986","journal-title":"Acta Neurochir"},{"issue":"6674","key":"bib12-20231011","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1136\/bmj.298.6674.636","article-title":"Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: british aneurysm nimodipine trial","volume":"298","author":"Pickard","year":"1989","journal-title":"BMJ"},{"issue":"2","key":"bib13-20231011","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1227\/00006123-198308000-00018","article-title":"Role of multiple cerebral microthrombosis in symptomatic cerebral vasospasm: with a case report","volume":"13","author":"Suzuki","year":"1983","journal-title":"Neurosurgery"},{"issue":"5","key":"bib14-20231011","doi-asserted-by":"crossref","first-page":"309","DOI":"10.2176\/nmc.30.309","article-title":"Cerebral microthrombosis in symptomatic cerebral vasospasm-a quantitative histological study in autopsy cases","volume":"30","author":"Suzuki","year":"1990","journal-title":"Neurol Med Chir"},{"issue":"3","key":"bib15-20231011","doi-asserted-by":"crossref","first-page":"702","DOI":"10.3171\/2017.5.JNS17831","article-title":"Dual antiplatelet therapy in aneurysmal subarachnoid hemorrhage: association with reduced risk of clinical vasospasm and delayed cerebral ischemia","volume":"129","author":"Nagahama","year":"2018","journal-title":"J Neurosurg"},{"issue":"6","key":"bib16-20231011","doi-asserted-by":"crossref","first-page":"E1037","DOI":"10.1093\/neuros\/nyz226","article-title":"The safety and efficacy of continuous tirofiban as a monoantiplatelet therapy in the management of ruptured aneurysms treated using stent-assisted coiling or flow diversion and requiring ventricular drainage","volume":"85","author":"Limaye","year":"2019","journal-title":"Neurosurgery"},{"issue":"3","key":"bib17-20231011","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1227\/NEU.0b013e31826213f9","article-title":"Safety and efficacy of tirofiban in stent-assisted coil embolization of intracranial aneurysms","volume":"71","author":"Chalouhi","year":"2012","journal-title":"Neurosurgery"},{"issue":"1","key":"bib18-20231011","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1093\/neuros\/nyx177","article-title":"Preliminary study of tirofiban infusion in coil embolization of ruptured intracranial aneurysms","volume":"82","author":"Yoon","year":"2018","journal-title":"Neurosurgery"},{"issue":"1","key":"bib19-20231011","doi-asserted-by":"crossref","first-page":"14","DOI":"10.7461\/jcen.2018.20.1.14","article-title":"Stent-Assisted coil embolization using only a glycoprotein IIb\/IIIa inhibitor (Tirofiban) for ruptured wide-necked aneurysm repair","volume":"20","author":"Lee","year":"2018","journal-title":"J Cerebrovasc Endovasc Neurosurg"},{"issue":"3","key":"bib20-20231011","doi-asserted-by":"crossref","first-page":"508","DOI":"10.3174\/ajnr.A4551","article-title":"Safety and efficacy of intravenous tirofiban as antiplatelet premedication for stent-assisted coiling in acutely ruptured intracranial aneurysms","volume":"37","author":"Kim","year":"2016","journal-title":"AJNR Am J Neuroradiol"},{"issue":"6","key":"bib21-20231011","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.2165\/00003495-199856060-00017","article-title":"Tirofiban. A review of its use in acute coronary syndromes","volume":"56","author":"McClellan","year":"1998","journal-title":"Drugs"},{"issue":"13","key":"bib22-20231011","doi-asserted-by":"crossref","first-page":"4594","DOI":"10.1182\/blood-2002-11-3566","article-title":"Desmopressin antagonizes the in vitro platelet dysfunction induced by GPIIb\/IIIa inhibitors and aspirin","volume":"102","author":"Reiter","year":"2003","journal-title":"Blood"},{"issue":"1","key":"bib23-20231011","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3171\/jns.1968.28.1.0014","article-title":"Surgical risk as related to time of intervention in the repair of intracranial aneurysms","volume":"28","author":"Hunt","year":"1968","journal-title":"J Neurosurg"},{"key":"bib24-20231011","first-page":"2825","article-title":"Scikit-learn: machine learning in python","volume":"12","author":"Pedregosa","year":"2011","journal-title":"J Mach Learn Res"},{"issue":"1","key":"bib25-20231011","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1161\/01.CIR.75.1.243","article-title":"Is vasospasm related to platelet deposition? Relationship in a porcine preparation of arterial injury in vivo","volume":"75","author":"Lam","year":"1987","journal-title":"Circulation"},{"issue":"10","key":"bib26-20231011","doi-asserted-by":"crossref","first-page":"2673","DOI":"10.1093\/brain\/awx214","article-title":"Subarachnoid blood acutely induces spreading depolarizations and early cortical infarction","volume":"140","author":"Hartings","year":"2017","journal-title":"Brain"},{"issue":"2","key":"bib27-20231011","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1038\/jcbfm.2011.169","article-title":"Delayed cerebral ischemia and spreading depolarization in absence of angiographic vasospasm after subarachnoid hemorrhage","volume":"32","author":"Woitzik","year":"2012","journal-title":"J Cereb Blood Flow Metab"},{"key":"bib28-20231011","doi-asserted-by":"crossref","first-page":"253746","DOI":"10.1155\/2014\/253746","article-title":"The role of arterioles and the microcirculation in the development of vasospasm after aneurysmal SAH","volume":"2014","author":"Naraoka","year":"2014","journal-title":"Biomed Res Int"},{"issue":"1","key":"bib29-20231011","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s12883-018-1217-y","article-title":"A case report of delayed cortical infarction adjacent to sulcal clots after traumatic subarachnoid hemorrhage in the absence of proximal vasospasm","volume":"18","author":"Schinke","year":"2018","journal-title":"BMC Neurol"},{"issue":"1","key":"bib30-20231011","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1136\/svn-2018-000192","article-title":"Safety of tirofiban and dual antiplatelet therapy in treating intracranial aneurysms","volume":"4","author":"Samaniego","year":"2019","journal-title":"Stroke Vasc Neurol"},{"issue":"6","key":"bib31-20231011","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.3171\/JNS\/2008\/108\/6\/1095","article-title":"Frequency of thromboembolic events associated with endovascular aneurysm treatment: retrospective case series","volume":"108","author":"Brooks","year":"2008","journal-title":"J Neurosurg"}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/neurosurgery\/article-pdf\/87\/5\/E552\/33880339\/nyaa170.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyaa170","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:55:59Z","timestamp":1786121759000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/neuros\/nyaa170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,16]]},"references-count":31,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyaa170","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,16]]}}}