Abstract Number: Esoc2026a1519 Investigating the Safety and Efficacy of Periprocedural Tirofiban Use in Mechanical Thrombectomy

Abstract Background and aims Approximately one third of patients with large vessel occlusion fail to achieve functional independence despite successful recanalisation following mechanical thrombectomy (MT), theorised to be secondary to incomplete restoration of microvascular perfusion. Periprocedural antiplatelet therapy may improve microvascular reperfusion. Tirofiban, a glycoprotein IIb/IIIa inhibitor commonly used in acute coronary syndrome, is occasionally used off-license during MT. This study compares outcomes following MT with and without periprocedural tirofiban at North Bristol NHS Trust (NBT). Methods A retrospective cohort study was conducted including patients who underwent MT at NBT between January and July 2025. Clinical records were reviewed to assess intracranial haemorrhage, mortality, recanalisation success, neurological outcomes, and stent re-occlusion. Results 186 patients were included (mean age 69.8 years), 20 received tirofiban. Intracranial haemorrhage occurred in 25.8% overall, with no significant difference between tirofiban (30%) and non-tirofiban groups (25.3%). Bleeding from other sources (15.0% tiro vs 3.0% non-tiro, p=0.013) and mass effect (15.0% tiro vs 3.6% non-tiro, p=0.025) were more frequent with tirofiban. Malignant MCA syndrome occurred only in non-tirofiban patients (3.8%). Successful recanalisation (TICI 2b–3) was achieved in 87.1%, with no difference in TICI outcomes (p=0.32). Three and 6-month mortality was comparable between groups. Conclusions Periprocedural tirofiban was not associated with increased intracranial haemorrhage, mortality, or recanalisation success but was associated with higher rates of extracranial bleeding and radiological mass effect Conflict of interest Hannah Timperley: nothing to disclose