When do you use tirofiban for acute ischemic stroke?

Early tirofiban infusion after IV thrombolysis makes sense for acute strokes due to intracranial stenosis. As an endovascular specialist, I have often seen MCA or basilar occlusions reopen with IV thrombolysis but only to reocclude when there is an underlying severe atherosclerotic lesion. My approach has been to use GP IIb/IIIa inhibitors, or even now Cangrelor in these scenarios. I think that these meds will help prevent rethrombosis of the vessel. I think that it is also important to start AS...

I agree with the prior post. This study appears to target acute ischemic stroke due to intracranial atherosclerotic disease (ICAD) etiology, where tirofiban (or other antiplatelet infusions) administered post-thrombolytics make mechanistic sense.

ICAD occlusions are "hot lesions", driven by active microinflammatory pathways within the plaque itself. Thrombolytics reduce fibrin deposition but don't address the underlying inflammation, so re-occlusion remains common. The rate-limiting step is that...