JAMA Netw Open

Tirofiban improves first-pass recanalization in acute stroke thrombectomy

April 22, 2025

IV tirofiban administered before endovascular thrombectomy significantly improves first-pass recanalization rates without increasing the risk of symptomatic intracranial hemorrhage. Consider tirofiban as a pre-procedure antiplatelet treatment to enhance thrombectomy outcomes in acute ischemic stroke patients.

Study details: OPTIMISTIC (NCT04851457), a phase 2 randomized clinical trial, included 200 patients (median age, 66 years; 73% male) with acute ischemic stroke due to large vessel occlusion. Participants received either IV tirofiban or placebo before undergoing endovascular thrombectomy. The primary endpoint was first-pass successful recanalization, defined as achieving successful reperfusion on the first thrombectomy attempt.

Results: In the intention-to-treat analysis, 64 of 99 patients receiving tirofiban (65%) and 46 of 95 control patients (48%) achieved the primary outcome of first-pass recanalization without symptomatic intracranial hemorrhage (adjusted risk ratio, 1.34; 95% confidence interval [CI], 1.04-1.73; P = .03). Symptomatic intracranial hemorrhage occurred in 0% of the tirofiban group vs. 6% of the control group (unadjusted risk difference, -0.06; 95% CI, -0.11 to -0.01).

Source:

Lin L, et al; OPTIMISTIC Investigators. (2025, April 1). JAMA Netw Open. Tirofiban on First-Pass Recanalization in Acute Stroke Endovascular Thrombectomy: The OPTIMISTIC Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/40244586/