Tirofiban combined with aspirin for branch atheromatous disease: a propensity score–matched study

Background The optimal antiplatelet approach for branch atheromatous disease (BAD) remains uncertain. We evaluated whether early administration of tirofiban plus aspirin (T + A) improves outcomes compared with dual antiplatelet therapy (DAPT) and assessed its potential as rescue therapy for early neurological deterioration (END). Methods This single-center retrospective cohort study included patients with acute BAD treated between November 2022 and August 2025. Patients received either T + A or DAPT. Propensity score matching (caliper 0.02) was performed to balance baseline characteristics. Primary outcomes were END within 7 days and excellent functional outcome (mRS 0–1) at 90 days; secondary outcomes included favorable outcome (mRS 0–2) and early neurological improvement. Results After matching, END occurred less frequently in the T + A group than in the DAPT group (10.1% vs. 55.1%; adjusted OR 0.08; 95% CI 0.03–0.20; p < 0.001). Excellent functional outcome at 90 days was more common with T + A (88.4% vs. 58.0%; adjusted OR 5.17; 95% CI 2.12–12.61; p < 0.001). T + A also improved early neurological recovery and favorable functional outcomes. Among patients who deteriorated on DAPT, exploratory rescue T + A was associated with improved recovery. No major bleeding increase was observed. These results are specific to this single-center cohort of Chinese patients with acute, mild-to-moderate BAD (NIHSS <15). Conclusion In this single-center cohort of Chinese patients with acute, mild-to-moderate BAD (NIHSS <15), tirofiban plus aspirin reduced END and improved 90-day functional outcomes. Exploratory evidence suggests it may also serve as a rescue therapy for patients deteriorating under DAPT. However, its efficacy and safety require validation in prospective, randomized studies.