Endovascular Therapy Combined With Tirofiban for Intracranial Atherosclerotic Acute Ischemic Stroke

Inclusion criteria

• Age ≥18 years
• Pre-stroke modified Rankin Scale (mRS) score of 0-1
• Acute ischemic stroke symptoms present within 24 hours of last known well time
• Baseline National Institutes of Health Stroke Scale (NIHSS) score ≥6
• Anterior circulation: Alberta Stroke Program Early CT Score (ASPECTS) ≥6 Posterior circulation: pc-ASPECTS ≥6
• Occlusion of intracranial internal carotid artery (ICA), M1 segment of middle cerebral artery (MCA), V4 segment of vertebral artery, or basilar artery
• Clinical care team plans to perform endovascular thrombectomy (EVT)
• Subject or legally authorized representative can provide informed consent
• Residual stenosis ≥50% without planned angioplasty/stenting

Exclusion criteria

• Intracranial hemorrhage confirmed by imaging prior to randomization, or major intracranial hemorrhage on intraprocedural flat-panel CT
• Gastrointestinal or genitourinary bleeding within 30 days post-stroke onset, or major surgery within 14 days
• Bleeding diathesis including coagulopathy (platelets <100×10⁹/L, aPTT >50s, or INR >2.0), DOAC use within 48 hours, or history of HIT
• Pregnancy or lactation at admission
• Contraindications to radiographic contrast agents, nickel, titanium or their alloys
• Life expectancy <6 months
• Pre-existing neurological/psychiatric conditions that may confound assessment
• Severe renal insufficiency (GFR <30mL/min or Scr >220μmol/L [2.5mg/dL])
• Arterial tortuosity or anomalies preventing device delivery
• Unlikely to complete 90-day follow-up
• Any confirmed cardioembolic source (including atrial fibrillation, valvular disease, intracardiac thrombus, recent MI, cardiomyopathy with EF <30%, etc.)
• Tirofiban or other GP IIb/IIIa inhibitor use before randomization or other GP IIb/IIIa inhibitor used post treatment