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.