Abstract Number: Esoc2026lt16 Lt16 - Safety and Efficacy of Low-Dose Tirofiban in Acute Ischemic Stroke Due to Tandem Lesions Undergoing Mechanical Thrombectomy (Atila Trial): A Multicenter, Randomized Clinical Trial

Abstract Background and aims Emergent carotid artery stenting (eCAS) plus antiplatelet drugs seems to be the most effective strategy in acute ischemic stroke (AIS) due to tandem lesion (TL), however antithrombotic strategy remains unclear. Our aim is to demonstrate that low-dose intravenous tirofiban is superior to intravenous aspirin in avoiding in-stent thrombosis in patients undergoing mechanical thrombectomy(MT) plus carotid stenting in the setting of AIS due to TL. Methods ATILA trial was a multicenter, prospective, randomized, open-label (PROBE design), assessor-blinded, investigator-initiated trial conducted in 13 stroke centers in Spain. Patients (aged ≥18 years) with acute ischemic stroke who presented within 24 hours due to atherosclerotic tandem lesion (⩾70% carotid stenosis or occlusion plus intracranial occlusion of carotid-T,MCA-M1/M2, ACA-A1, or fetal PCA), ASPECTS ≥6, and undergoing MT with planned emergent carotid stenting were randomized (1:1) with a computer-generated randomization sequence to low-dose IV tirofiban (500μg bolus + 20-hour infusion 200μg/h) or single-dose of IV-aspirin. Primary efficacy and safety outcomes were the proportion of patients with carotid in-stent thrombosis within the first 24 h after MT and the rate of sICH by intention-to-treat analysis. Secondary endpoint included mRS 0-2 at 90 days. Registered at ClinicalTrials.gov, NCT05225961. Results Between January 1, 2022, and December 31, 2025, we randomly assigned 240 patients, 120 in each group. Main efficacy and safety results will be available in April 2026, pending data lock and statistical review. Conclusions ATILA trial evaluates whether tirofiban improves stent patency in tandem lesions in AIS without excess bleeding. Conflict of interest