Expanding Treatment for Acute Ischemic Stroke beyond Revascularization

This editorial discusses the limited reach of thrombolysis and thrombectomy in acute ischemic stroke treatment and explores tirofiban a glycoprotein IIb/IIIa inhibitor as a potential therapy for patients ineligible for revascularization. The RESCUE BT2 trial (1177 patients, China) compared intravenous tirofiban followed by aspirin versus aspirin alone in patients without large vessel occlusion. Tirofiban significantly improved functional outcomes at 90 days (mRS 0–1: 29.1% vs. 22.2%) despite a slightly higher rate of symptomatic intracerebral hemorrhage (1.0% vs. 0%). Mechanistically, tirofiban may enhance microcirculatory flow and reduce infarct volume. While encouraging, the authors caution that results require broader confirmation before widespread use. Prior tirofiban trials showed mixed efficacy, and generalizability beyond Chinese populations may be limited.

This editorial discusses the limited reach of thrombolysis and thrombectomy in acute ischemic stroke treatment and explores tirofiban a glycoprotein IIb/IIIa inhibitor as a potential therapy for patients ineligible for revascularization. The RESCUE BT2 trial (1177 patients, China) compared intravenous tirofiban followed by aspirin versus aspirin alone in patients without large vessel occlusion. Tirofiban significantly improved functional outcomes at 90 days (mRS 0–1: 29.1% vs. 22.2%) despite a slightly higher rate of symptomatic intracerebral hemorrhage (1.0% vs. 0%). Mechanistically, tirofiban may enhance microcirculatory flow and reduce infarct volume. While encouraging, the authors caution that results require broader confirmation before widespread use. Prior tirofiban trials showed mixed efficacy, and generalizability beyond Chinese populations may be limited.