Design: Multicentre, double-blind, placebo-controlled RCT
Population: 970 patients with BAD-related acute ischaemic stroke within 48 h, 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 to 1.19)

STRATEGY randomised 970 patients at 38 Chinese hospitals with MRI-confirmed branch atheromatous disease-related ischaemic stroke within 48 hours of onset to 24 hours of intravenous tirofiban or placebo, on a background of aspirin. It was double-blind and published in JAMA Neurology in August.

Early neurological deterioration within 7 days or new stroke within 90 days occurred in 17.1% with tirofiban and 19.6% with placebo (HR 0.88, 95% CI 0.65 to 1.19). Moderate or severe bleeding was rare (1 patient versus none).

Branch atheromatous disease is a common cause of progressive lacunar-type stroke in Asian populations, and escalated antiplatelet therapy is often tried. This trial does not support tirofiban for that purpose.

Suspect branch atheromatous disease with a lenticulostriate or pontine infarct extending to the parent artery.
Do not add intravenous tirofiban routinely to prevent deterioration.
Monitor NIHSS closely in the first 72 hours.
Follow standard secondary prevention after the acute phase.

Why it matters

It removes one of the escalation strategies commonly tried for progressive lacunar-type stroke in Asia.

The statistics, in plain English

The hazard ratio of 0.88 has an interval from 0.65 to 1.19, which includes both a modest benefit and a small harm. The trial rules out a large benefit but cannot exclude a small one. The comparator was aspirin alone, not dual antiplatelet therapy.