protocolSection identificationModule nctId: NCT06373042, orgStudyIdInfo id: ADJUVANT-2, briefTitle: Tirofiban for Successful Endovascular Stroke Thrombectomy, acronym: ADJUVANT-2, statusModule overallStatus: NOT_YET_RECRUITING, startDateStruct date: 2024-07-31, primaryCompletionDateStruct date: 2026-07-31, completionDateStruct date: 2026-10-31, studyFirstPostDateStruct date: 2024-04-18, lastUpdatePostDateStruct date: 2024-04-18, sponsorCollaboratorsModule leadSponsor name: Zhongming Qiu, class: OTHER, collaborators name: The Second Affiliated Hospital of Chongqing Medical University, collaborators name: Mianyang Central Hospital, collaborators name: The Second Hospital of Jiaozuo, collaborators name: Chongzhou People's Hospital, collaborators name: Xihua People's Hospital, collaborators name: Xingguo People's Hospital, descriptionModule briefSummary: Up to 50% of acute ischemic stroke patients with large vessel occlusion failed to achieve functional independence even after successful reperfusion therapy, a phenomenon that is referred to as "futile recanalization". The mechanism of futile recanalization is complex, and some studies have shown that it may be related to factors such as tissue no reflow, reocclusion, poor status of collateral circulation, hemorrhagic transformation, impaired cerebrovascular autonomic regulation, and low perfusion volume. Several studies suggested that maximizing the improvement of cerebral reperfusion is still the primary goal of acute large vessel occlusive stroke. Structural and functional alterations in the microvascular system may be a major obstacle to reperfusion. In animal models of cerebral ischemia, downstream microvascular thrombosis may occur in the early stage of cerebral ischemia and before vascular recanalization, which is the main factor leading to incomplete reperfusion and affecting the efficacy of endovascular thrombectomy.Mechanical thrombectomy mainly addressed the occluded large arteries, and does not consider the distal arteries. However, the recanalization of occluded large arteries does not necessarily translate into successful reperfusion of the ischemic tissue supplied by the distal capillaries. Even with complete recanalization, impaired microcirculatory reperfusion may lead to poor clinical outcomes. Therefore, we speculate that at the end of endovascular thrombectomy, microthrombi remain present in the microcirculation of brain tissue in patients with complete or near-complete cerebral angiography, and that microthrombi is more likely to be dissolved than thrombus more proximal to the heart. Therefore, intra-arterial administration of pharmaceutical, such as tirofiban, may be the only possible option to ensure complete reperfusion of ischemic tissue. Tirofiban is a platelet glycoprotein IIb/IIIa receptor antagonist, which has been widely used in acute coronary syndrome, and its role in acute ischemic stroke has attracted more and more attention from stroke experts. Previous studies have suggested that tirofiban can further increase the incidence of successful recanalization, while reducing the reocclusion rate.Whether early administration of intraarterial and intravenous tirofiban can further improve the clinical outcomes of patients with large vessel occlusive stroke after successful mechanical thrombectomy remains unclear., conditionsModule conditions: Stroke, Acute Ischemic, designModule studyType: INTERVENTIONAL, phases: PHASE2, phases: PHASE3, designInfo allocation: RANDOMIZED, interventionModel: PARALLEL, primaryPurpose: TREATMENT, maskingInfo masking: QUADRUPLE, whoMasked: PARTICIPANT, whoMasked: CARE_PROVIDER, whoMasked: INVESTIGATOR, whoMasked: OUTCOMES_ASSESSOR, enrollmentInfo count: 712, type: ESTIMATED, armsInterventionsModule interventions name: Intraarterial and intravenous tirofiban, interventions name: Intraarterial and intravenous placebo, outcomesModule primaryOutcomes measure: Functional independence, secondaryOutcomes measure: Recanalization on follow-up CTA or MRA, secondaryOutcomes measure: Early neurologic improvement, secondaryOutcomes measure: Level of disability, secondaryOutcomes measure: Excellent outcome, secondaryOutcomes measure: Independent ambulation, secondaryOutcomes measure: Health-related quality of life, secondaryOutcomes measure: Long-term of disability level, secondaryOutcomes measure: Health-related quality of life (long-term), secondaryOutcomes measure: Incidence of symptomatic intracranial hemorrhage (SICH), secondaryOutcomes measure: Radiologic intracranial hemorrhage rate, secondaryOutcomes measure: Mortality, secondaryOutcomes measure: Incidence of non-hemorrhagic serious adverse events, eligibilityModule sex: ALL, minimumAge: 18 Years, stdAges: ADULT, stdAges: OLDER_ADULT, contactsLocationsModule, hasResults: False