Safety and Efficacy of Short-Term Tirofiban Combined with Dual Antiplatelet Therapy after Flow Diverter Placement for Intracranial Aneurysms: A Multicenter Retrospective Study and Nomogram for Thromboembolic Event Prediction

Xiaoning Liu¹Yunpeng Lin¹Bingcheng Ren¹Yang Li¹Jiwen Wang¹Xiangbo Liu¹Yidi Wang¹Chenguagn Guo²Fushun Xiao^1*Shiqing Mu^3*

• ¹Tianjin Medical University General Hospital, Tianjin, China
• ²Nankai District Center for Disease Control and Prevention, tianjin, China
• ³Beijing Tiantan Hospital Department of Interventional Neuroradiology, Beijing, China

ABSTRACT Background Flow diverters (FDs) are increasingly applied for intracranial aneurysms, but their high metal coverage raises thromboembolic risk. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is standard, yet clopidogrel resistance, especially in Asian populations, reduces efficacy. Tirofiban, a glycoprotein IIb/IIIa inhibitor, may enhance perioperative protection. This study evaluated the safety and efficacy of adding short-term tirofiban to DAPT after FDs treatment and developed a model to predict thromboembolic events (TEEs). Methods We retrospectively analyzed 319 patients with unruptured aneurysms treated with FDs across multiple centers (2018–2022). Patients received either DAPT alone (group 1) or DAPT plus tirofiban (group 2). After propensity score matching (140 per group), ischemic and hemorrhagic complications were compared. Predictive factors for TEEs were identified using Lasso-logistic regression, and a nomogram was constructed. Results A total of 389 aneurysms in 319 patients were included in the statistical analysis. There were no statistically significant differences in the baseline characteristics of the patients and aneurysms between the groups, indicating comparability. After PSM, 140 patients were included in each group for comparison. The group 1 vs. the group 2 (Early postoperative complications): TEEs (3.6% vs. 5.0%, P = 0.768), intracranial hemorrhage (0% vs. 0.7%, P = 0.390); The group 1 vs. the group 2 (Long-term postoperative complications): TEEs (3.3% vs. 5.7%, P = 0.370), intracranial hemorrhage (3.6% vs. 1.4%, P = 0.444), and peripheral bleeding events (2.9% vs. 6.5%, P = 0.256) showed no statistically significant differences. Multivariable logistic regression identified maximum aneurysm diameter (OR = 1.153, 95% CI: 1.087–1.223, P < 0.0001) as significant risk factor for TEEs, while diameter of the feeding artery (OR = 0.442, 95% CI: 0.286–0.682, P = 0.0003) was protective factor. A nomogram based on these factors achieved a C-index of 0.723. Conclusion Tirofiban combined with DAPT in flow diverter treatment for intracranial aneurysms demonstrated good safety without increasing bleeding risk, though its efficacy advantage over DAPT alone was not evident. The proposed nomogram enables individualized TEE risk prediction and supports personalized antiplatelet management.