Design: Multicentre, double-blind, placebo-controlled randomised trial
Population: 970 patients with MRI-confirmed branch atheromatous disease stroke within 48 h
Primary outcome: Early neurological deterioration by day 7 or new stroke by day 90
Effect: 17.1% vs 19.6%; HR 0.88 (95% CI 0.65 to 1.19)

The STRATEGY trial, published in JAMA Neurology on 1 October 2026, randomised 970 patients at 38 Chinese hospitals with MRI-confirmed stroke from branch atheromatous disease, within 48 hours of onset, to a 24-hour intravenous infusion of tirofiban or placebo. All received aspirin 300 mg then 100 mg daily. Median age was 63.

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; P = 0.39). Moderate or severe bleeding was rare in both groups (one case with tirofiban).

Branch atheromatous disease — infarcts at the origin of a penetrating artery, often in the pons or basal ganglia — deteriorates early in a substantial minority, and intensive antiplatelet therapy has been tried on the hope of preventing it. This trial does not support adding tirofiban. It did not test dual oral antiplatelet therapy, which remains a separate question.

Do not add intravenous tirofiban to aspirin for branch atheromatous stroke on the basis of current evidence.
Recognise the pattern on MRI: an infarct reaching the parent artery origin in the pons or lenticulostriate territory.
Monitor these patients closely in the first week; about one in five deteriorated or had a new stroke.
Manage antiplatelet therapy according to current minor-stroke guidance.

Why it matters

It closes off one intensive antiplatelet option for a stroke subtype with no proven way to prevent early worsening.

The statistics, in plain English

A hazard ratio of 0.88 with an interval from 0.65 to 1.19 includes both a modest benefit and a modest harm, so the trial cannot show tirofiban helps. The very low bleeding rate is reassuring but does not change the efficacy result.