2026 American Academy of Neurology Abstract Website

Objective:

To characterize the clinical course, indications, and outcomes of consecutive AIS (and TIA) patients who received intravenous tirofiban for neurological worsening at our tertiary care centre.

Background:

Glycoprotein IIb/IIIa inhibition with intravenous tirofiban has emerged as a rescue option for acute ischemic stroke (AIS) patients who deteriorate despite standard therapies, particularly in settings of neurological fluctuation, infarct progression, or high risk of reocclusion. Although recent meta-analyses suggest potential benefit, clear clinical indications and patient selection remain under investigation.

Design/Methods:

We retrospectively analysed nine patients (mean age 68 years; 6 males) treated with intravenous tirofiban between April and October 2025. Detailed chart review captured demographics, stroke features, indication for tirofiban, baseline and post-infusion NIHSS, modified Rankin Scale (mRS), comorbidities, imaging, and ancillary interventions.

Tirofiban was initiated primarily for:

(i) stuttering or fluctuating neurological deficits,

(ii) post-thrombolysis deterioration,

(iii) progression despite optimal antiplatelet therapy, or

(iv) presumed high-risk thrombotic or re-occlusive lesions (notably basilar artery stenosis, large vessel occlusion, or capsular warning syndromes).

TIROFIBAN DOSE: IV 25ml bolus dose over 30 mins duration; followed by 8ml/hr for 23.5-47.5hrs duration.

Results:

A total of 9 patients were studied with median NIHSS on arrival was 5 (mean 5.9), falling to 1 (mean 1.9) after tirofiban. Eight patients (67%) had marked neurological recovery; 1 died during 6 months follow up owing to malignant brainstem infarction. No symptomatic intracranial hemorrhage was captured; with commendable symptomatic stabilization & all patients received standard adjunctive secondary prevention.

Conclusions:

Intravenous tirofiban was most often employed as a rescue for stuttering symptoms, progression post-thrombolysis, or high-risk arterial lesions not eligible for thrombectomy. The majority experienced significant neurological improvement, but sample size and lack of systematized sICH monitoring are noted limitations. These real-world data complement recent literature and support ongoing trials of tirofiban rescue in carefully selected AIS populations. RCT remain essential for same.