Tirofiban for Stroke without Large or Medium-Sized Vessel Occlusion

This multicenter, double-blind, randomized RESCUE BT2 trial evaluated intravenous tirofiban versus oral aspirin in 1177 Chinese patients with acute ischemic stroke but no occlusion of large or medium-sized vessels. Eligible patients presented within 24 hours and were either ineligible for reperfusion therapy or showed symptom progression or deterioration post-thrombolysis. Tirofiban was administered intravenously for 48 hours, followed by oral aspirin through day 90; control patients received aspirin and IV placebo. At 90 days, 29.1% of the tirofiban group achieved excellent outcomes (modified Rankin score 0–1) versus 22.2% with aspirin (adjusted RR 1.26; P=0.02). Secondary endpoints including functional independence and global outcomes showed mixed results. Mortality was similar between groups (3.8% vs. 2.6%), while symptomatic intracranial hemorrhage was slightly more common with tirofiban (1.0% vs. 0%). Most infarcts were small and atherosclerotic. Findings suggest tirofiban may improve early stroke outcomes in patients without major vessel occlusion but warrant caution and further validation.

This multicenter, double-blind, randomized RESCUE BT2 trial evaluated intravenous tirofiban versus oral aspirin in 1177 Chinese patients with acute ischemic stroke but no occlusion of large or medium-sized vessels. Eligible patients presented within 24 hours and were either ineligible for reperfusion therapy or showed symptom progression or deterioration post-thrombolysis. Tirofiban was administered intravenously for 48 hours, followed by oral aspirin through day 90; control patients received aspirin and IV placebo. At 90 days, 29.1% of the tirofiban group achieved excellent outcomes (modified Rankin score 0–1) versus 22.2% with aspirin (adjusted RR 1.26; P=0.02). Secondary endpoints including functional independence and global outcomes showed mixed results. Mortality was similar between groups (3.8% vs. 2.6%), while symptomatic intracranial hemorrhage was slightly more common with tirofiban (1.0% vs. 0%). Most infarcts were small and atherosclerotic. Findings suggest tirofiban may improve early stroke outcomes in patients without major vessel occlusion but warrant caution and further validation.