To systematically evaluate the efficacy and safety of adjunctive intravenous tirofiban in patients undergoing angioplasty and stenting for ICAD-related stroke.

Intracranial atherosclerotic disease (ICAD) is a primary cause of ischemic stroke, with high recurrence rates despite optimal medical therapy. Endovascular treatment (EVT) is reserved for high-risk patients, but periprocedural thrombotic complications remain a significant challenge.  Tirofiban is a potent and reversible glycoprotein IIb/IIIa inhibitor that has a short plasma half-life. It offers powerful antiplatelet effects during the procedure with a rapid return to normal platelet function, though this benefit must be weighed against hemorrhagic risk.

A systematic literature search adhering to PRISMA guidelines was performed. This search identified six comparative studies, comprising one randomized controlled trial and five retrospective observational cohorts. These studies compared angioplasty and stenting with versus without adjunctive intravenous tirofiban for ICAD. Primary outcomes were good functional outcome (modified Rankin Scale 0-2) at 90 days, symptomatic intracranial hemorrhage (sICH), and all-cause mortality. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using a random-effects model.

The analysis demonstrated that adjunctive tirofiban was significantly associated with a higher likelihood of a good functional outcome at 90 days (OR 1.59, 95% CI 1.07-2.37; p=0.02). There was no statistically significant difference in the odds of sICH (OR 1.33, 95% CI 0.61-2.89; p=0.47) or all-cause mortality (OR 0.91, 95% CI 0.48-1.72; p=0.76) between the groups.

In patients undergoing endovascular treatment for ICAD-related stroke, adjunctive intravenous tirofiban significantly improves the odds of a good 90-day functional outcome without a statistically significant increase in symptomatic intracranial hemorrhage or mortality. These findings support the consideration of adjunctive tirofiban in routine clinical practice for this high-risk patient population and should encourage the design of randomized controlled trials to further confirm and refine the role of this potent antiplatelet agent in the neurointerventional field.