Abstract Number: Esoc2026lt59 Lt59 - Tirofiban After Successful Endovascular Recanalization for Acute Ischemic Stroke: The Attraction Randomized Clinical Trial

Abstract Background and aims Successful recanalization without functional independence is common after endovascular thrombectomy in stroke. The effect of tirofiban, a glycoprotein IIb/IIIa receptor antagonist, after successful endovascular treatment is unclear. Methods In this multicenter, double-blind, randomized trial at 82 centers in China, patients with anterior-circulation large vessel occlusion stroke achieving successful recanalization (modified Thrombolysis In Cerebral Infarction score 2b-3) after endovascular treatment were assigned to receive tirofiban (intra-arterial bolus, 5 μg/kg, followed by intravenous infusion at 0.1 μg/kg/min for 24 hours) or placebo. The primary efficacy outcome was functional independence, defined as modified Rankin scale (mRS) score of 0–2 at 90 days. Safety outcomes were symptomatic intracranial hemorrhage within 48 hours and death at 90 days. Results A total of 689 patients were assigned to the tirofiban group and 691 to the placebo group. The percentage of patients with a mRS score of 0–2 at 90 days was 49.4% in the tirofiban group and 43.3% in the placebo group (unadjusted risk ratio, 1.14 95% CI, 1.02-1.28; P=0.02; adjusted risk ratio, 1.15 95% CI, 1.03-1.27; P=0.01). Symptomatic intracranial hemorrhage occurred in 11.9% with tirofiban and 9.4% with placebo (adjusted risk ratio, 1.24 95% CI, 0.91-1.68; P=0.17); 90-day mortality was 18.3% and 19.0%, respectively (adjusted hazard ratio, 0.96 95% CI, 0.75-1.22; P=0.72). Conclusions In patients with acute anterior-circulation large vessel occlusion stroke achieving successful recanalization, adjunct tirofiban increased the likelihood of functional independence at 90 days without increasing the risk of symptomatic intracranial hemorrhage or mortality. (ClinicalTrials.gov number, NCT06265051.) Conflict of interest