HR-MRI-Directed Tirofiban Therapy for Late-Window Acute Ischemic Stroke (TIAN)

Prior treatment

• Planned to receive reperfusion therapy (endovascular therapy or intravenous thrombolysis)；
• Concurrent new cerebral infarction in both anterior and posterior circulations;
• Concurrent participation in other therapeutic clinical trials with incomplete treatment and follow-up;

Other illness

• Intracranial hemorrhage confirmed by computed tomography (CT)；
• History of atrial fibrillation or current electrocardiogram indicating atrial fibrillation；
• Acute ischemic stroke caused by other etiologies, such as Moyamoya disease, arterial dissection, arteritis, etc；
• Known contraindications to antiplatelet therapy, including hematochezia, gastrointestinal bleeding, or any other hemorrhagic disorders;
• History of hypersensitivity to aspirin;
• Definite indication for anticoagulant therapy expected during the study period (e.g., atrial fibrillation, mechanical heart valve, deep vein thrombosis, pulmonary embolism, antiphospholipid antibody syndrome, hypercoagulable state, etc.);
• Severe heart failure (New York Heart Association \[NYHA\] Functional Classification Class III or IV);
• Presence of other known neurological disorders that may complicate the follow-up;
• Other conditions that the investigators consider inappropriate for enrollment in this study.

Lab values

• Complicated with malignant tumors, chronic hemodialysis, severe renal insufficiency (glomerular filtration rate \[GFR\] \< 30 ml/min or serum creatinine \[Cr\] \> 220 μmol/L (2.5 mg/dl)), or severe hepatic insufficiency (serum alanine aminotransferase \[ALT\] \> 2 times the upper limit of normal \[ULN\], or serum aspartate aminotransferase \[AST\] \> 2 times the ULN);

Other

• Definite or suspected cardiogenic embolism；
• Imaging examinations indicating that the area of the current cerebral infarction exceeds 1/2 of the area of a single cerebral lobe;
• Complicated with severe non-cardiovascular comorbidities, with an estimated survival time \< 6 months;
• Inability to complete the follow-up procedures;

• Age ≥ 18 years old;
• Acute ischemic stroke (AIS) in the anterior intracranial circulation (internal carotid artery system) confirmed by clinical symptoms and imaging examinations;
• Time from symptom onset or last known normal state to randomization: \> 24 hours and ≤ 7 days;
• Stroke subtype confirmed as intracranial large artery atherosclerosis (ICAS) by high-resolution vessel wall imaging (HR-VWI) according to the TOAST classification, with cardiogenic embolism and other etiologies excluded;
• Baseline National Institutes of Health Stroke Scale (NIHSS) score of 4-20 at the time of randomization;
• Signed informed consent form obtained from the patient or their legal representative.