Dual-energy CT-guided early tirofiban therapy improves 90-day functional outcomes after mechanical thrombectomy in acute ischemic stroke: A retrospective cohort study

Background and purpose After mechanical thrombectomy (MT) for acute ischemic stroke (AIS), immediate computed tomography (CT) often reveals hyperdense lesions ≥ 10 mm³ in the target vessel area.Conventional CT cannot reliably differentiate between contrast retention and hemorrhage, which may delay antiplatelet therapy (e.g., tirofiban) or increase the risk of bleeding. Methods A total of 152 AIS patients with anterior circulation large vessel occlusion, who developed the aforementioned hyperdense lesions within 24 hours after MT, were retrospectively enrolled from January 2022 to June 2024. Patients were assigned to either the DECT-guided early tirofiban group (n = 72), in whom pure contrast retention was confirmed and tirofiban was initiated within 24 hours; and the conventional delayed treatment group (n = 80), in which patients either did not undergo DECT or had suspected hemorrhage, with tirofiban administered after a 24–48-hour delay. The primary endpoint was the proportion of patients with modified Rankin Scale (mRS) scores of 0–2 at 90 days. Secondary endpoints included 24-hour improvement in National Institutes of Health Stroke Scale (NIHSS) scores, early neurological deterioration (END), vascular reocclusion, symptomatic intracerebral hemorrhage (sICH), and 90-day mortality. Results Baseline characteristics were well balanced between the two groups. The rate of favorable functional outcome (mRS 0–2) at 90 days was significantly higher in the DECT-guided early tirofiban group compared with the conventional group (65.3% vs. 42.5%, χ² = 8.27, P = 0.004). Neurological improvement at 24 hours, as measured by NIHSS score reduction, was significantly greater, and the rates of END and vascular reocclusion were lower in the DECT-early tirofiban group (8.3% vs. 22.5%, 6.9% vs. 18.8%, respectively). No statistically significant differences were observed in sICH, asymptomatic intracerebral hemorrhage (aICH), or 90-day mortality between the two groups (all P > 0.05). Conclusion In AIS patients undergoing MT with DECT-confirmed pure contrast retention, early initiation of tirofiban within 24 hours is safe and improves the likelihood of favorable functional outcomes at 90 days, without increasing bleeding risk.