Design: Multicentre, double-blind, placebo-controlled randomised trial
Population: 970 patients with branch atheromatous disease stroke within 48 hours, China
Primary outcome: Early neurological deterioration within 7 days or new stroke within 90 days
Effect: 17.1% vs 19.6%, HR 0.88 (95% CI 0.65–1.19)

STRATEGY randomised 970 patients at 38 Chinese hospitals with MRI-confirmed stroke from branch atheromatous disease — occlusion at the origin of a penetrating artery — within 48 hours of onset. Patients received a 24-hour intravenous infusion of tirofiban or placebo, and all received aspirin. The primary outcome was early neurological deterioration within 7 days or new stroke within 90 days.

The primary outcome occurred in 17.1% with tirofiban and 19.6% with placebo (HR 0.88), not a significant difference. Moderate or severe bleeding was rare: one patient on tirofiban and none on placebo.

Branch atheromatous disease is common in Asian populations and notorious for stepwise worsening in the first days. This trial does not support routine tirofiban to prevent it. The low bleeding rate means the question is not closed for selected patients, but outside a trial the evidence now points against it.

Recognise branch atheromatous disease on MRI: lesions at the origin of a penetrating artery, often in the pons or lenticulostriate territory
Warn patients and families about the risk of early worsening
Do not use tirofiban routinely to prevent deterioration
Follow standard antiplatelet and risk-factor management

Why it matters

A widely tried strategy for a common Asian stroke subtype has now failed its first large trial.

The statistics, in plain English

HR 0.88 (95% CI 0.65–1.19) crosses 1, so no benefit was shown; the interval allows anything from a 35% reduction to a 19% increase. A small benefit cannot be excluded, but a large one is unlikely.