Intravenous Tirofiban After Bridging Therapy for Acute Stroke With Atherosclerotic Large Artery Occlusion

Inclusion criteria

• Age ≥18 years old.
• Pre-mRS 0-2.
• Baseline NIHSS 6-30 points.
• Baseline ASPECTS ≥6 points.
• Baseline CTA/MRA diagnosed: the ICA or MCA-M1/M2 occlusion.
• Receiving bridging therapy (EVT following IV Tenecteplase) within 24 hours from stroke onset.
• Baseline DSA diagnosed: ICAD related LVO.

• ICAD-related LVO is assumed if any one the following criteria is fulfilled: (1) absence of atrial fibrillation; (2) truncal-type occlusion; (3) residual stenosis ≥30% on DSA after the first retriever; (4) researchers determined it to be ICAD-related LVO based on the TOAST classification.
• Patients have achieved successful reperfusion after EVT (mTICI ≥2b).
• Patients or their eligible surrogates provided informed consent.

Exclusion criteria

• Previously known permanent, persistent, or paroxysmal atrial fibrillation.
• Permanent stenting during EVT;
• Patient had severe bleeding or the following conditions, such as active gastrointestinal ulcer, aortic dissection, platelet count <100 ×109/L, hemoglobin <100 g/L, INR≥1.7 in the last 6 months.
• Contraindication to glycoprotein IIb/IIIa inhibitors.
• Imaging examination (Flat-panel NCCT/DCT) before randomization showed the following: Heidelberg hemorrhage type 1c, 2, or 3 ICH with or without clinical exacerbation (an increase of ≥4 points in the NIHSS score from baseline or an increase of ≥2 points in any of the NIHSS scores or resulting in intubation, decompression of bone valves, ventricular drainage, or other significant medical/surgical intervention), infarct area greater than 50% of the middle cerebral artery blood supply area or infarct volume ≥70ml, cerebral hernia signs.
• Vascular malformations, arterial dissection, intracranial aneurysms, tumors (except for small meningiomas), cerebrovascular inflammation, cerebral amyloid angiopathy, or other major non-ischemic craniocerebral diseases (e.g. multiple sclerosis) as diagnosed by head imaging.
• Acute renal failure, dialysis, or estimated glomerular filtration rate (eGFR) < 30ml/min/1.72m2, or serum creatinine > 220mmol/L (2.5mg/dl).
• History of severe liver disease, or aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) and/or glutamyltransferase (GGT) ≥3×ULN and/or total bilirubin (TBIL) ≥2×ULN.
• Acute ST elevation myocardial infarction (MI), acute decompensated heart failure, QTc>500 ms, hospitalization or involuntary coronary intervention due to acute coronary syndrome, MI, cardiac arrest within the past 3 months.
• Severe non-cardiovascular comorbidity with life expectancy < 3 months (e.g., malignant tumors).
• Any clinical conditions determined by the study team that may limit adherence to the study process.
• Currently receiving an investigational drug or device.
• Women of childbearing age not practicing reliable contraception who do not have a documented negative pregnancy test.
• The subject's informed consent was not obtained.