Tandem Occlusion to Thrombolysis in Cerebral Infarction (TICI) 3: A Case of Perioperative Tirofiban for Carotid Artery Stenting.

Large vessel occlusions associated with ipsilateral high-grade extracranial internal carotid artery stenosis, also called tandem occlusions, remain under investigation for optimal management. The risk of in-stent thrombosis is heightened for those who undergo carotid stenting in conjunction with mechanical thrombectomy (MT). Tirofiban, an intravenous antiplatelet agent functioning by binding the GIIb/IIIa receptors, inhibits platelet aggregation and has been used in cases of tandem occlusions to reduce the risk of in-stent thrombosis. Unfortunately, the bleeding risk is elevated in patients who receive intraoperative antithrombotics during stenting procedures, and especially those who undergo reperfusion therapy with prior fibrinolytic therapy. We present a case of tirofiban used to reduce the risk of in-stent thrombosis during MT and stenting of a carotid terminus tandem occlusion in a 64-year-old man. We aim to compare our case with currently published data on tirofiban use during similar procedures, with regard to indications for treatment, hemorrhagic events, and functional outcomes.