Impact of Preemptive vs. Conventional Tirofiban Administration on the Outcomes in Acute Branch Atheromatous Disease: A Propensity Score-Weighted Cohort Study.

BACKGROUND: Branch atheromatous disease (BAD) carries a high risk of early neurological deterioration (END). We evaluated the efficacy of preemptive tirofiban administration within 72 h compared with reactive rescue therapy following END. METHODS: This retrospective, single-center study enrolled 221 patients with BAD-associated stroke. Based on the timing of tirofiban administration, patients were assigned to a preemptive intervention group (n = 127) or a conventional intervention group (n = 94). Preemptive intervention was defined as preemptive administration after clinical risk assessment, whereas conventional intervention was delayed until an increase of ≥ 2 points on the NIHSS score. Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates. Multivariable regression analysis was performed to identify independent predictors of an excellent 90-day outcome, defined as a modified Rankin Scale (mRS) score ≤ 1. RESULTS: After IPTW adjustment, the preemptive intervention group showed a significantly higher rate of excellent 90-day outcomes (76.6% vs. 44.6%, p < 0.001) and a shorter median hospital stay (10 vs. 11 days, p = 0.02) compared with the conventional group. No between-group differences were observed in mortality or stroke recurrence (p > 0.05). Early tirofiban use (adjusted OR = 4.411, 95% CI: 2.349-8.283) and a lower baseline NIHSS score (adjusted OR = 0.832, 95% CI: 0.707-0.980) independently predicted favorable outcomes. Subgroup analyses confirmed consistent benefits across most strata, with patients aged over 65 years deriving greater neuroprotection (p = 0.004 for age-treatment interaction). CONCLUSION: Preemptive administration of tirofiban within the initial 72 h significantly improves 90-day neurological outcomes and reduces hospital stay length in patients with BAD-related stroke.