Efficacy and Safety of Tirofiban for Patients With BAD (BRANT)

Prior treatment

• Have received or plan to receive endovascular therapy or thrombolysis after onset;
• Use of tirofiban within 1 week before or after onset
• History of trauma or major surgical intervention within 6 weeks prior to onset
• Active or recent history(within 30 days prior to onset) of clinical bleeding (e.g., gastrointestinal bleeding)
• Have participated in another clinical trial within 3 months prior to the date of informed consent, or are participating in another clinical trial.

Other illness

• Intracranial hemorrhagic diseases, vascular malformations, aneurysms, brain abscesses, malignant space-occupying lesions, or other non-ischemic intracranial lesions detected by baseline CT/MRI, or MRA/CTA/DSA;
• Cardiogenic embolism: atrial fibrillation, myocardial infarction, heart valve disease, dilated cardiomyopathy, infective endocarditis, atrioventricular block disease, heart rate less than 50 beats per minute
• Stroke of other clear causes, e.g., moyamoya disease, arterial dissection, vasculitis, etc.
• Known malignant tumors
• History of intracranial hemorrhage
• Malignant hypertension (systolic blood pressure \>200 mmHg, or diastolic blood pressure \>120 mmHg)

Lab values

• Low platelets (\<100×10\^9 /L), or Prothrombin time \>1.3 times of the upper normal limit, or INR \>1.5, or other systemic hemorrhagic tendencies such as hematologic disorders
• Elevation of ALT or AST more than 1.5 times the upper normal limit;

Other

• Transient ischemic attack (TIA)
• Presence of ≥50% stenosis in extracranial artery in tandem relationship ipsilateral to the lesion;
• modified Rankin Scale ≥2 before onset
• Glomerular filtration rate \<60 ml/min/1.73m\^2
• Life expectancy ≤ 6 months
• Contraindications of 3 T MRI examination
• Pregnant or lactating women

• Age: 18-75 years old
• Acute ischemic stroke
• Time from onset to randomization ≤48h; if onset time is unknown, time from last known well to randomization ≤48h
• Meet the following BAD Diagnostic Imaging Criteria
  • 4.1. DWI infarcts: single (isolated) deep (subcortical) infarcts;
  • 4.2. The culprit arteries are either Lenticulostriate artery (LSA) or Paramedian pontine artery (PPA), and the infarct lesion on DWI conforms to one of the following characteristics (A/B): A. LSA: 1) "Comma-like" infarct lesions with "Fan-shaped" extension from bottom to top in the coronal plane; or 2) ≥ 3 layers (layer thickness 5-7 mm) on axial DWI brain images; B. PPA: The infarct lesion extends from the deep pons to the ventral pons on the axial DWI brain images;
  • 4.3. No more than 50% stenosis on the parent artery of the criminal artery (i.e. corresponding basilar or middle cerebral artery) (Confirmed by magnetic resonance angiography \[MRA\] or computed tomography angiography \[CTA\] or digital substraction angiography \[DSA\]).
• Singed informed consent by the patient or legally authorized representatives.