Intravenous Tirofiban Versus Thrombolysis Before Mechanical Thrombectomy in Stroke

Prior treatment

• Current participation in other drug clinical trials;

Other illness

• Acute intracranial hemorrhage on admission;
• Pretreatment with intravenous thrombolysis after index stroke;
• Significant pre-stroke disability defined as a modified Rankin scale (mRS) score greater than 2;
• Allergy to radiographic contrast agents, nickel, titanium metals or their alloys;
• Arterial tortuosity and/or other arterial disease that would prevent the thrombectomy device from reaching the target vessel;
• Patient with a preexisting neurological or psychiatric disease that would confound the outcome assessments;
• Any terminal disease with a life expectancy less than half a year.

Other

• Contraindication to intravenous thrombolytics or tirofiban;
• Known pregnancy or lactation;
• Radiologically confirmed mass effect or intracranial tumor except for small meningioma;
• Radiologically confirmed intracranial arteriovenous malformation or aneurysm.

• Aged 18 years or older;
• Acute ischemic stroke patient eligible for intravenous thrombolysis who are present within 4.5 hours of last known well, or present within 4.5-24 hours of last known well with demonstrated salvageable brain tissue (defined as an estimated ischemic core volume \<70 ml, a mismatch ratio ≥1.8 and a mismatch volume ≥15 ml);
• Occlusion of the internal carotid artery, M1 or M2 segment of the middle cerebral artery, or basilar artery confirmed by CTA or MRA;
• Endovascular thrombectomy is planned by clinical care team;
• Informed written consent obtained from patients or their legal representatives.