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

Dual-energy CT-guided early tirofiban therapy improves 90-day functional outcomes after mechanical thrombectomy in acute ischemic stroke: A retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Dual-energy CT-guided early tirofiban therapy improves 90-day functional outcomes after mechanical thrombectomy in acute ischemic stroke: A retrospective cohort study Wei Li, Longting Du, Li Huang, Gangjing Li, Jing Chen, Lianlian He, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7826178/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract 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. Dual-energy CT Tirofiban Neuroregulation Acute ischemic stroke Limb dysfunction Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Mechanical thrombectomy (MT) is now the standard of care for acute large vessel occlusion stroke and has significantly improved functional outcomes[1]. Clinical data demonstrate that the successful recanalization rate of MT can exceed 70%; however, a considerable proportion of patients remain unable to achieve functional independence at 90 days postoperatively. Vascular reocclusion and hemorrhagic transformation are well-recognized key factors affecting prognosis[2,3]. In non-contrast CT (NCCT) examinations within 24 hours after MT, approximately 30%–50% of patients present hyperdense lesions in the target vessel area. These lesions may be either contrast medium retention (benign, resulting from contrast extravasation or residue during endovascular treatment) or true hemorrhage (including symptomatic or asymptomatic intracerebral hemorrhage, which necessitates avoidance of antithrombotic therapy) [4]. Conventional NCCT only assesses lesions roughly based on CT density values, and the imaging manifestations of these two conditions overlap (e.g., the CT value of contrast medium retention may approximate that of fresh hemorrhage). This makes immediate postoperative differentiation challenging, leading to delayed initiation of antithrombotic agents—particularly drugs for preventing thrombus reformation. Statistics indicate that approximately 20%–40% of patients with contrast medium retention miss the opportunity for early antithrombotic therapy due to suspected hemorrhage, increasing the risk of vascular reocclusion (reocclusion rate can reach 10%–25% within 24 hours postoperatively) [5]. Dual-energy CT (DECT) utilizes dual-energy scanning (typically 80kV and 140kV) and iodine-water separation technology to quantitatively measure the iodine concentration in hyperdense lesions. Theoretically, it can accurately identify contrast medium (characterized by significantly increased iodine concentration) and true hemorrhage (characterized by extremely low or no iodine signal). Multiple small-sample studies have confirmed that the sensitivity and specificity of DECT for distinguishing these two conditions exceed 90%, providing an objective basis for early postoperative antithrombotic decision-making [6,7]. Tirofiban—a fast-acting, reversible platelet glycoprotein IIb/IIIa (GPIIb/IIIa) receptor antagonist with a short half-life (approximately 2 hours)—potently inhibits platelet aggregation, and its antiplatelet effect is rapidly reversible following drug withdrawal. In previous small-scale prospective studies, tirofiban administration in post-MT patients not only improved cerebral microvascular perfusion (confirmed by perfusion imaging) and reduced vascular reocclusion rate but also did not significantly increase the risk of symptomatic intracerebral hemorrhage, demonstrating a favorable risk-benefit ratio [8,9,10]. Currently, data regarding the efficacy and safety of DECT-guided early tirofiban administration in post-MT patients—particularly in large-sample studies—remain scarce. In this retrospective cohort study (152 patients finally enrolled), we systematically evaluated the efficacy and safety of DECT-guided early tirofiban initiation. By comparing clinical outcomes between the DECT-early tirofiban group (tirofiban initiated within 24 hours postoperatively in patients with DECT-confirmed contrast medium retention) and the conventional delayed treatment group (antithrombotic therapy initiated after a 24–48-hour delay in patients without DECT or with suspected hemorrhage), we verified whether this strategy could improve patients’ 90-day functional prognosis by optimizing the timing of antithrombotic therapy—without increasing bleeding risk—thereby providing evidence-based support for precise decision-making regarding antithrombotic therapy following MT in patients with AIS. Methods Study Population Patients who underwent endovascular treatment in the Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, from January 2022 to June 2024 (note: time range unified to align with enrolled patient data in Results) were screened for eligibility. Inclusion Criteria:① Meeting the criteria for emergency endovascular recanalization therapy as outlined in the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke (2018)[11] ;② Aged > 18 years;③ Acute ischemic stroke caused by anterior circulation large vessel occlusion (intracranial segment of the internal carotid artery, middle cerebral artery M1 segment, or proximal M2 segment) with successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] grade 2b–3). The mTICI is a widely used previously published scale for assessing endovascular recanalization efficacy (Higashida et al., 2003)[12];④ Underwent mechanical thrombectomy, with hyperdense lesions ≥ 10 mm³ in the target vessel area on immediate post-MT CT (≤ 2 hours);⑤ Availability of complete clinical data and written informed consent from patients or their legal representatives. Exclusion Criteria:① Cardioembolic stroke (e.g., caused by atrial fibrillation);② Non-atherosclerotic cerebral infarction;③ Use of anticoagulants or pre-existing abnormal platelet function;④ Incomplete medical records;⑤ Presence of contraindications to tirofiban or DECT scanning.The study flow is shown in Fig. 1 . Grouping Criteria DECT-Early Tirofiban Group Patients underwent DECT scanning immediately postoperatively (≤ 2 hours) using a GE Revolution CT 256 device. Scanning parameters were as follows: tube voltage of 80kV and 140kV, adaptive tube current adjustment, and slice thickness of 0.6mm. Iodine maps and water maps were generated using dedicated post-processing software (syngo.via)[13,14]. Criteria for Pure Iodine Retention: Hyperdense lesions in the target vessel area were defined as pure iodine retention if they exhibited an iodine concentration ≥ 2 mg/mL on iodine maps and a CT value < 10 HU on corresponding water maps (hemorrhagic components were excluded, given that the CT value of fresh hemorrhage on water maps typically exceeds 20 HU). Lesions meeting these criteria were considered to have no bleeding risk. All images were independently reviewed by two experienced neuroradiologists, with an inter-rater agreement κ value of 0.87 [15,16]. Conventional Delayed Treatment Group Patients were assigned to this group if they either did not undergo DECT or underwent DECT but met any of the following criteria (defined as suspected hemorrhage or uncertain lesion nature):No DECT: Only relying on immediate post-MT conventional NCCT, with hyperdense lesions showing blurred boundaries, irregular shapes, or accompanying local edema—making clinical exclusion of hemorrhage difficult;DECT-suspected hemorrhage: Iodine concentration of hyperdense lesions < 2 mg/mL on iodine maps, CT value ≥ 10 HU on water maps (suggesting possible mixed hemorrhagic components), or iodine concentration and water map values in the critical range (iodine concentration 1–2 mg/mL and water map value 8–12 HU)—precluding clear exclusion of hemorrhage. See Fig. 2 . Tirofiban Administration Regimen DECT-Early Tirofiban Group:Patients meeting the criteria for pure iodine retention initiated tirofiban therapy within 24 hours postoperatively: a loading dose of tirofiban was administered via intravenous pump at a rate of 0.4 µg·kg⁻¹·min⁻¹ for 30 minutes to rapidly inhibit platelet aggregation, and after the loading dose, a maintenance dose of tirofiban was continuously infused via intravenous pump at a rate of 0.1 µg·kg⁻¹·min⁻¹ for 24 hours to consolidate the antiplatelet effect and prevent thrombus reformation [17,18,19,20] During drug administration, patients’ blood pressure, heart rate, and bleeding tendency (e.g., mucocutaneous bleeding, gingival bleeding) were closely monitored. In the event of severe adverse reactions (e.g., sudden decrease in platelet count, active bleeding), the drug was immediately discontinued and symptomatic treatment was administered. Conventional Delayed Treatment Group:Patients in this group did not receive tirofiban or other antiplatelet agents immediately. NCCT reexamination was performed 24–48 hours later:If hyperdense lesions completely disappeared or significantly faded (consistent with contrast medium metabolism) on reexamination, antithrombotic therapy was initiated (tirofiban regimen identical to that of the DECT-early group);If hyperdense lesions were confirmed as hemorrhage (unchanged density or accompanied by mass effect) on reexamination, antiplatelet agents were prohibited, and treatment was provided in accordance with cerebral hemorrhage guidelines (e.g., blood pressure control, intracranial pressure reduction). Outcome Measures Both primary and secondary outcome measures were defined, with secondary outcomes evaluated within 90 days postoperatively or during hospitalization. Primary Outcome: The primary outcome was the proportion of patients with modified Rankin Scale (mRS; Rankin, 1957) scores ≤ 2 at 90 days postoperatively, which was used to assess long-term functional prognosis[21]. The mRS ( Rankin, 1957) is a well-validated previously published tool for evaluating post-stroke functional recovery. Secondary Outcomes: 24-hour NIHSS improvement: ≥4-point decrease in National Institutes of Health Stroke Scale (NIHSS;Brott et al., 1989) score from baseline at 24 hours postoperatively [22]. The NIHSS is a clinically established previously published scale for quantifying acute neurological deficits;Early neurological deterioration (END): ≥4-point increase in NIHSS (Brott et al., 1989) score within 24 hours postoperatively or death within 7 days postoperatively;Symptomatic intracerebral hemorrhage (sICH): Confirmed by CT/MRI reexamination, with a ≥ 4-point increase in NIHSS (Brott et al., 1989) score compared with that before hemorrhage (per ECASS-III criteria);Asymptomatic intracerebral hemorrhage (aICH): Newly identified intracerebral hemorrhage on imaging without concurrent neurological deterioration; 90-day all-cause mortality: Death from any cause within 90 days postoperatively;Postoperative vascular reocclusion rate: Vascular reocclusion was defined as target vessel blood flow grade ≤ mTICI (Higashida et al., 2003) 2a (confirmed by CT angiography [CTA], magnetic resonance angiography [MRA], or digital subtraction angiography [DSA] within 24 hours postoperatively), and the incidence was calculated accordingly. Statistical Analysis SPSS 26.0 or R 4.3.0 software was used for statistical analysis. Continuous variables were tested for normality using the Shapiro-Wilk test: normally distributed variables were expressed as mean ± standard deviation (x̄±SD), while skewed variables were presented as median (interquartile range) [M (P25, P75)]. Categorical variables were described as frequency (percentage) [n (%)].Baseline Comparison Between Groups: Independent samples t-test was used for normally distributed continuous variables with homogeneous variance; otherwise, the Mann-Whitney U test was applied. The χ² test was used for categorical variables, and Fisher’s exact test was substituted when the expected frequency was < 5.Propensity Score Matching (PSM): 1:1 nearest-neighbor PSM (caliper value = 0.02) was employed to balance age, baseline NIHSS (Brott et al., 1989) score, occlusion site, and time from symptom onset to endovascular treatment—all of which are key factors affecting stroke prognosis. No cases were excluded after matching (72 cases in the DECT group, 80 cases in the conventional group), and the standardized mean difference (SMD) of all variables was < 0.1 (age: 0.05, baseline NIHSS: 0.08, occlusion site: 0.06, time from onset to treatment: 0.07), indicating good baseline balance.Primary Outcome: The proportion of patients with mRS(Rankin, 1957) ≤ 2 at 90 days was compared using the χ² test. Multivariate Logistic regression was performed to adjust for gender and diabetes history (screened by univariate analysis with P < 0.10), and the odds ratio (OR) with 95% confidence interval (CI) was calculated. The Hosmer-Lemeshow test was used to evaluate model goodness-of-fit (χ²=5.28, P = 0.726).Secondary Outcomes: The χ² test or Fisher’s exact test was used for binary variables (24-hour NIHSS (Brott et al., 1989) improvement, END, sICH, aICH, 90-day all-cause mortality, vascular reocclusion rate); repeated measures analysis of variance or Wilcoxon rank-sum test was used for dynamic changes in continuous NIHSS (Brott et al., 1989) scores.A two-tailed test was used, and P < 0.05 was considered statistically significant. The Bonferroni method was applied for multiple comparison correction of the α value. Results A total of 412 patients with acute anterior circulation large vessel occlusive ischemic stroke who met the eligibility criteria were screened from January 2022 to June 2024, and 152 were finally enrolled (72 in the DECT-early tirofiban group, 80 in the conventional delayed treatment group). After PSM, baseline characteristics were well balanced between the two groups (all SMD < 0.1). Baseline Characteristics No statistically significant differences were observed between the two groups in terms of age, gender, comorbidities, baseline NIHSS(Brott et al., 1989) score, time from symptom onset to endovascular treatment, occlusion site, or immediate post-MT hyperdense lesion volume (all P > 0.05), indicating good comparability.Distribution of comorbidities: In the DECT-early tirofiban group, 42 (58.3%) had hypertension, 21 (29.2%) had diabetes mellitus, and 18 (25.0%) had a smoking history; in the conventional delayed treatment group, 45 (56.2%) had hypertension, 23 (28.8%) had diabetes mellitus, and 20 (25.0%) had a smoking history.Immediate post-MT hyperdense lesion volume (skewed distribution, expressed as median [interquartile range]): 18.5 (12.3, 25.6) mm³ in the DECT-early tirofiban group and 19.2 (11.8, 26.3) mm³ in the conventional delayed treatment group, with no statistically significant difference (Z = 0.28, P = 0.780) (Table 1 ). Table 1 Comparison of baseline characteristics between the DECT-early tirofiban group (n = 72) and the conventional delayed treatment group (n = 80) Early Tirofiban Conventional Treatment Statistical P -Value Group (n = 72) Group (n = 80) Value Age 65.2 ± 10.3 64.8 ± 9.7 t = 0.23 0.818 Gender 41/31 45/35 χ²=0.05 0.823 Hypertension 51 (70.8) 57 (71.2) χ²=0.00 0.965 Diabetes mellitus 23 (31.9) 25 (31.2) χ²=0.01 0.917 Smoking history 28 (38.9) 30 (37.5) χ²=0.03 0.862 Baseline NIHSS score 14 (10–18) 15 (11–19) Z=-0.57 0.568 Time from onset to endovascular treatment 5.2 ± 1.8 5.4 ± 2.0 t=-0.61 0.543 Occlusion site χ²=0.32 0.852 Intracranial segment of internal carotid artery 18 (25.0) 21 (26.2) Middle cerebral artery M1 segment 42 (58.3) 45 (56.2) Proximal M2 segment of middle cerebral artery 12 (16.7) 14 (17.5) mTICI χ²=0.45 0.798 Grade 2b 25 (34.7) 28 (35.0) χ²=0.23 0.818 Grade 3 47 (65.3) 52 (65.0) χ²=0.05 0.823 Immediate post-procedural hyperdense lesion volume 18.6 ± 5.2 19.1 ± 4.9 t=-0.55 0.583 Note: NIHSS(Brott et al., 1989) = National Institutes of Health Stroke Scale (evaluates neurological deficits); mTICI(Higashida et al., 2003) = modified Thrombolysis in Cerebral Infarction scale (assesses post-endovascular recanalization).Data expression: Normally distributed continuous variables: mean ± standard deviation (x ± s); skewed continuous variables (e.g., baseline NIHSS(Brott et al., 1989) score): median (interquartile range) [M (P25, P75)]; categorical variables: frequency (percentage) [n (%)]. All baseline characteristics showed no significant differences between the two groups (all P > 0.05), indicating good comparability. Primary Outcome The proportion of patients with mRS (Rankin, 1957) ≤ 2 at 90 days was significantly higher in the DECT-early tirofiban group than in the conventional delayed treatment group (65.3% vs. 42.5%, χ²=8.27, P = 0.004). Multivariate Logistic regression analysis showed that DECT-guided early tirofiban use was an independent protective factor for favorable 90-day functional prognosis after adjusting for gender and diabetes history (screened by univariate analysis with P < 0.10) (OR = 2.53, 95% CI: 1.36–4.72, P = 0.003). The model exhibited good goodness-of-fit (Hosmer-Lemeshow test, P = 0.726) (Table 2 and Fig. 3 ). Table 2 mRS scores of patients with three months after discharge[n(%)] Early Tirofiban Conventional Treatment χ² p n 72 80 mRS ≤ 2 47(65.3) 34(42.5) 8.27 0.004* Note:*P < 0.05 Secondary Outcomes Neurological Function Improvement and Deterioration 24-hour NIHSS (Brott et al., 1989) Improvement: In the DECT-early tirofiban group, 49 patients (68.1%) achieved a ≥ 4-point decrease in NIHSS (Brott et al., 1989) score from baseline at 24 hours; in the conventional delayed treatment group, 36 patients (45.0%) achieved this improvement. The proportion of patients with early neurological function improvement was significantly higher in the DECT-early tirofiban group (χ²=7.31, P = 0.007, OR = 2.56, 95% CI: 1.30–5.05), suggesting that this treatment strategy more effectively promotes neurological function recovery within 24 hours postoperatively.END Incidence: Six patients (8.3%) in the DECT-early tirofiban group developed END (defined as a ≥ 4-point increase in NIHSS (Brott et al., 1989) score within 24 hours or death within 7 days), while 18 patients (22.5%) in the conventional delayed treatment group developed END. The incidence of END was significantly lower in the DECT-early tirofiban group (χ²=5.49, P = 0.019, OR = 0.31, 95% CI: 0.12–0.81), indicating that early tirofiban initiation reduces the risk of postoperative neurological deterioration (Table 3 ). Table 3 Comparison of secondary outcomes between the two groups Outcome Early Tirofiban Conventional Treatment χ² p OR (95%CI) indicators Group (n = 72) Group (n = 80) 24h NIHSS improvement 49 (68.1) 36 (45.0) χ²=7.31 0.007* 2.56 (1.30–5.05) Early neurological deterioration 6 (8.3) 18 (22.5) χ²=5.49 0.019* 0.31 (0.12–0.81) sICH 5 (6.9) 7 (8.8) χ²=0.19 0.663 0.76 (0.24–2.41) aICH 9 (12.5) 11 (13.8) χ²=0.07 0.795 0.88 (0.35–2.18) 90-day all-cause death 1 (1.4) 2 (2.5) χ²=0.15 0.698 0.55 (0.05–5.87) Postoperative vascular reocclusion 5 (6.9) 15 (18.8) χ²=4.62 0.032* 0.32 (0.11–0.92) Note:All secondary outcomes were assessed within 90 days postoperatively or during hospitalization; *P < 0.05 indicates statistical significance. Bleeding and Mortality No statistically significant differences in bleeding events or mortality were observed between the two groups:sICH: 5 cases (6.9%) in the DECT-early tirofiban group and 7 cases (8.8%) in the conventional delayed treatment group (χ²=0.19, P = 0.663, OR = 0.76, 95% CI: 0.24–2.41);aICH: 9 cases (12.5%) in the DECT-early tirofiban group and 11 cases (13.8%) in the conventional delayed treatment group (χ²=0.07, P = 0.795, OR = 0.88, 95% CI: 0.35–2.18);90-day All-Cause Mortality: 1 case (1.4%) in the DECT group and 2 cases (2.5%) in the conventional group. Fisher’s exact test was used due to an expected frequency < 5, and no significant difference was found (P = 0.685, OR = 0.55, 95% CI: 0.05–5.87) (Table 3 ). Vascular Reocclusion The postoperative vascular reocclusion rate (defined as target vessel reocclusion confirmed by CTA/MRA/DSA within 24 hours postoperatively, with blood flow grade (≤ mTICI;Higashida et al., 2003) 2a) was 6.9% (5/72) in the DECT-early tirofiban group and 18.8% (15/80) in the conventional delayed treatment group. The reocclusion rate was significantly lower in the DECT-early tirofiban group (χ²=4.62, P = 0.032, OR = 0.32, 95% CI: 0.11–0.92), suggesting that early tirofiban therapy effectively reduces the risk of target vessel reocclusion after thrombectomy (Table 3 and Fig. 4 ). Subgroup Analysis After Bonferroni correction for multiple comparisons (adjusted α = 0.0125):In the subgroup of patients aged 0.0125), aged ≥ 65 years (χ²=3.95, P = 0.047 > 0.0125), with middle cerebral artery M1 segment occlusion (χ²=5.12, P = 0.024 > 0.0125), and with intracranial internal carotid artery occlusion (χ²=4.01, P = 0.045 > 0.0125), the proportion of patients with mRS (Rankin, 1957) ≤ 2 at 90 days was higher in the DECT-early tirofiban group (68.2%, 62.1%, 66.7%, 63.5%, respectively) than in the conventional delayed treatment group (45.1%, 39.8%, 43.3%, 41.2%, respectively). However, no differences reached statistical significance after correction, suggesting a consistent trend of efficacy across subgroups—though verification in larger samples is needed (detailed results in Table 4 ). Table 4 Comparison of the proportion of patients with 90-day mRS ≤ 2 between the two groups in different subgroups Stratification Factor Group n mRs ≤ 2(n) mRs ≤ 2(%) χ² P Age Early Tirofiban 42 29 68.2 4.89 0.027* (< 65 years) Conventional Treatment 40 18 45.1 Age Early Tirofiban 29 18 62.1 3.95 0.047* (≥ 65 years) Conventional Treatment 40 16 39.8 Occlusion Site Early Tirofiban 42 28 66.7 5.12 0.024* M1 Conventional Treatment 30 13 43.3 Occlusion Site Early Tirofiban 27 17 63.5 4.01 0.045* ICA Conventional Treatment 34 14 41.2 Note: M1 = Middle Cerebral Artery M1 segment; ICA = Intracranial Segment of Internal Carotid Artery.This table shows subgroup analyses of the primary outcome (90-day mRS(Rankin, 1957) ≤ 2, indicating favorable functional prognosis), stratified by age (< 65 vs. ≥ 65 years) and occlusion site (M1 vs. ICA).Unadjusted P-values are provided; no differences were statistically significant after Bonferroni correction (adjusted α = 0.0125), yet the DECT-early tirofiban group had a consistently higher proportion of mRS(Rankin, 1957) ≤ 2 across all subgroups. Sensitivity Analysis Two methods were used to verify the robustness of the results, and neither interfered with the core conclusion:Extreme Case Exclusion: After excluding 5 patients with baseline NIHSS (Brott et al., 1989) ≥ 30 (2 in the DECT-early group, 3 in the conventional group), multivariate Logistic regression reanalysis showed that DECT-guided early tirofiban use remained an independent protective factor for favorable 90-day functional prognosis (OR = 2.48, 95% CI: 1.31–4.69, P = 0.005)—a result close to that of the total population analysis (OR = 2.53, 95% CI: 1.36–4.72, P = 0.003), indicating no significant impact of extreme cases on the conclusion.PSM Caliper Value Adjustment: After adjusting the PSM caliper value from 0.02 to 0.05, samples were rematched (63 cases in the DECT-early group, 65 cases in the conventional group), and the baseline SMD remained < 0.1 (indicating good balance). The proportion of patients with mRS(Rankin, 1957) ≤ 2 was 64.8% (41/63) in the DECT-early group, which remained significantly higher than the 43.1% (28/65) in the conventional group (χ²=7.92, P = 0.005), confirming that changes in analysis conditions did not alter the core conclusion. Discussion In this retrospective analysis of 152 patients with hyperdense lesions ≥ 10 mm³ after MT for acute anterior circulation large vessel occlusive ischemic stroke, we found that DECT-guided early tirofiban initiation significantly increased the rate of favorable 90-day functional prognosis (mRS (Rankin, 1957) ≤ 2), reduced the risks of END and postoperative vascular reocclusion, and did not elevate the risks of sICH, aICH, or 90-day all-cause mortality. These findings provide robust evidence to support individualized antithrombotic decision-making following MT in AIS patients.. The core finding of this study is that DECT-guided early tirofiban use significantly improves 90-day functional prognosis (65.3% vs. 42.5%, OR = 2.53, 95% CI: 1.36–4.72)—a result closely linked to the technical advantages of DECT in accurately distinguishing contrast medium retention from hemorrhage and the pharmacological properties of tirofiban. Accurate identification of the nature of early postoperative hyperdense lesions is a key bottleneck in antithrombotic decision-making. Conventional NCCT can only assess lesions based on density values and cannot distinguish between benign contrast medium retention and true hemorrhage (which requires avoiding antithrombotic therapy). This leads to delayed antithrombotic therapy in approximately 20%–40% of patients with contrast medium retention due to suspected hemorrhage, increasing the risk of vascular reocclusion (10%–25%)[23,24]. In contrast, DECT can accurately identify pure contrast medium retention via 80kV/140kV dual-energy scanning and iodine-water separation technology (iodine concentration ≥ 2 mg/mL and water map CT value < 10 HU) [25,26]. In this study, the inter-observer agreement for image interpretation reached κ = 0.87, providing a reliable objective basis for early antithrombotic therapy. As a potent, reversible GPIIb/IIIa receptor antagonist with a half-life of only 2 hours, tirofiban rapidly inhibits platelet aggregation, and its effects are reversible [27,28] In this study, the postoperative vascular reocclusion rate was significantly lower in the early tirofiban group than in the conventional group (6.9% vs. 18.8%, OR = 0.32), confirming its role in preventing thrombus reformation. Additionally, the higher 24-hour NIHSS (Brott et al., 1989) improvement rate (68.1% vs. 45.0%) and lower END incidence (8.3% vs. 22.5%) in the early tirofiban group suggest that reduced vascular reocclusion risk directly promotes early neurological function recovery—ultimately translating to improved 90-day functional prognosis. The results of this study are consistent with those of previous small-sample studies but extend the evidence base by including a larger sample size and enhancing precision. Previous studies have confirmed that DECT has a sensitivity and specificity of > 90% for distinguishing contrast medium retention from hemorrhage [29], and tirofiban use after MT reduces reocclusion rate without increasing bleeding risk[30,31]. The innovation of this study lies in the first verification of the value of the “DECT identification + early tirofiban” combined strategy in a relatively large sample (152 cases). Furthermore, PSM was used to balance baseline confounders (SMD < 0.1), and subgroup analysis and sensitivity analysis confirmed the stability of the results—enhancing the reliability of the conclusion. Notably, no significant differences in sICH, aICH, or mortality were observed between the two groups (all P > 0.05); even the 90-day mortality rate was as low as 1.4% in the early tirofiban group, which was not statistically different from the 2.5% in the conventional group. This result supports the safety of tirofiban but requires interpretation in the context of its use: DECT initiates treatment only when “pure iodine retention” (no hemorrhagic components) is confirmed, avoiding administration in high-bleeding-risk populations and thus balancing efficacy and safety. This contrasts with the concern that “blind early antithrombotic therapy may increase bleeding risk”, suggesting that “precise patient stratification” is a prerequisite for the safe use of antithrombotic agents [32,33]. Subgroup analysis further verified the population applicability trend of the DECT-guided early tirofiban strategy: regardless of patient age (< 65 vs. ≥65 years) or occlusion site (middle cerebral artery M1 segment vs. intracranial internal carotid artery), the proportion of patients with mRS (Rankin, 1957) ≤ 2 at 90 days was higher in the DECT-early tirofiban group than in the conventional delayed treatment group. However, no differences reached statistical significance after Bonferroni correction for multiple comparisons (α = 0.0125), suggesting a consistent efficacy trend across subgroups—though verification in larger samples is needed. This dispels the concern that “elderly patients or those with specific occlusion sites may not benefit from early antithrombotic therapy”: after DECT screening for patients with “pure contrast medium retention,” early tirofiban use (a reversible GPIIb/IIIa receptor antagonist) can both “reduce reocclusion risk” and “avoid increased bleeding.” Additionally, the middle cerebral artery M1 segment and intracranial internal carotid artery are high-incidence sites of anterior circulation occlusion (postoperative reocclusion rate 15%–25%), making the efficacy advantages of this strategy more clinically relevant. Sensitivity analysis supported the robustness of the conclusion from a methodological perspective: after excluding extreme cases with baseline NIHSS (Brott et al., 1989) ≥ 30, the OR value of the protective effect of DECT-guided drug use only fluctuated from 2.53 to 2.48 (with high 95% CI overlap), and the efficacy trend remained unchanged; after adjusting the PSM caliper value, baseline balance was still maintained and significant differences in primary outcomes persisted—excluding the impact of analysis condition bias. This study provides an actionable pathway for antithrombotic decision-making after MT: for patients with immediate postoperative hyperdense lesions, DECT can serve as a “precise screening tool” to identify those with pure contrast medium retention via iodine maps and water maps. Such patients can safely initiate tirofiban within 24 hours (loading dose: 0.4 µg·kg⁻¹·min⁻¹ for 30 minutes; maintenance dose: 0.1 µg·kg⁻¹·min⁻¹ for 24 hours) to reduce reocclusion risk and improve neurological function. This strategy is particularly suitable for patients with anterior circulation large vessel occlusion (e.g., intracranial internal carotid artery or middle cerebral artery M1 segment occlusion), who have a higher postoperative reocclusion risk and may derive greater benefit from early antithrombotic therapy. Limitations This study has several limitations: first, it has a retrospective design, which inherently introduces selection bias; although propensity score matching (PSM) was employed to balance baseline confounders, unmeasured confounding factors (e.g., postoperative blood pressure fluctuations, variations in concomitant medications) may still persist. Second, outcome assessment relies on 90-day follow-up, with a lack of long-term (e.g., 6-month or 1-year) functional prognosis data. Third, we did not explore the impact of DECT examination timing (e.g., 1 hour vs. 2 hours postoperatively) on decision-making, nor did we compare the efficacy of tirofiban with that of other antiplatelet agents (e.g., aspirin combined with clopidogrel). Future Perspectives Future prospective randomized controlled trials (RCTs) are needed to further verify the efficacy of the DECT-guided strategy, explore its applicability in patients with different occlusion sites (e.g., posterior circulation), determine the optimal dose and course of tirofiban (e.g., whether prolonged maintenance therapy further reduces reocclusion rate), and evaluate the value of DECT combined with other imaging technologies (e.g., cerebral perfusion imaging) in optimizing antithrombotic decision-making. If subsequent studies confirm its generalizability, the DECT-guided early antithrombotic strategy is anticipated to serve as a valuable supplement to standardized post-MT treatment. Abbreviations AIS Acute Ischemic Stroke MT Mechanical Thrombectomy DECT-Dual Energy Computed Tomography CT Computed Tomography NCCT Non-contrast Computed Tomography mRS Modified Rankin Scale NIHSS National Institutes of Health Stroke Scale END Early Neurological Deterioration sICH Symptomatic Intracerebral Hemorrhage aICH Asymptomatic Intracerebral Hemorrhage mTICI modified Thrombolysis in Cerebral Infarction GPIIb/IIIa Glycoprotein IIb/IIIa CTA CT Angiography MRA Magnetic Resonance Angiography DSA Digital Subtraction Angiography PSM Propensity Score Matching SMD Standardized Mean Difference OR Odds Ratio CI Confidence Interval RCT Randomized Controlled Trials ICA I nternal Carotid Artery Declarations Abbreviations AIS Acute Ischemic Stroke MT Mechanical Thrombectomy DECT-Dual Energy Computed Tomography CT Computed Tomography NCCT Non-contrast Computed Tomography mRS Modified Rankin Scale NIHSS National Institutes of Health Stroke Scale END Early Neurological Deterioration sICH Symptomatic Intracerebral Hemorrhage aICH Asymptomatic Intracerebral Hemorrhage mTICI modified Thrombolysis in Cerebral Infarction GPIIb/IIIa Glycoprotein IIb/IIIa CTA CT Angiography MRA Magnetic Resonance Angiography DSA Digital Subtraction Angiography PSM Propensity Score Matching SMD Standardized Mean Difference OR Odds Ratio CI Confidence Interval RCT Randomized Controlled Trials ICA I nternal Carotid Artery Declarations Ethics approval and consent to participate The study protocol was approved by the Ethics Committee of Chongqing Hospital of Traditional Chinese Medicine (approval No.: 2025-IIT-KS-15). Given the retrospective and observational nature of this study, the requirement for informed consent was waived by the aforementioned ethics board. To protect patient privacy, all clinical data utilized in the study were fully de-identified prior to analysis.This study was conducted in strict compliance with the ethical principles outlined in the World Medical Association Declaration of Helsinki (including its 2013 revision). Additionally, this manuscript adheres to the applicable guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), ensuring the transparency and rigor of reporting for observational research. Consent for publication Not applicable. Conflict of interest The authors have no conflicts of interest to disclose. Funding Author Contribution Wei Li, Longting Du and Li Huang were responsible for study conception and design. Wenyan Yang and Lianlian He collected the clinical data and prepared the manuscript. Gangjing Li and Jing Chen performed the data analyses and wrote the manuscript. Jun Tang and Jianwei Zhu were significantly involved in the analysis with constructive discussions, editing and revision of the manuscript. All authors have read and approved the final version of the manuscript. Data Availability The data generated and analyzed in this research are accessible from the corresponding author upon reasonable request. Those seeking the data should provide a concise explanation of the intended purpose and relevant research qualifications, and all data sharing will adhere to applicable ethical standards and institutional regulations. References Yang X, Liu C, Li S, et al. Efficacy and safety of early anticoagulation after endovascular treatment in patients with atrial fibrillation. Stroke and Vascular Neurology. 2023;8(5):405–413. Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019-1030. 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CT-based radiomics for differentiating intracranial contrast extravasation from intraparenchymal haemorrhage after mechanical thrombectomy. Eur Radiol. 2022;32(7):4771-4779. Kellert L, Hametner C, Rohde S, et al. Endovascular stroke therapy: tirofiban is associated with risk of fatal intracranial hemorrhage and poor outcome. Stroke. 2013;44(5):1453-1455. Baik SK, Oh SJ, Park KP, et al. Intra-arterial tirofiban infusion for partial recanalization with stagnant flow in hyperacute cerebral ischemic stroke. Interv Neuroradiol. 2011;17(4):442-451. Zhu L, Xie F, Li X, Bei J, Li H, Sun W, Song F. Safety and efficacy of intravenous tirofiban infusion after mechanical thrombectomy in acute ischemic stroke: a retrospective observational study. Am J Transl Res. 2021;13(8):9076-9085. Roberts L, Shirazi S, Graham B, Woods R. Tirofiban for stroke without large- or medium-sized vessel occlusion. CJEM. 2025;27(8):603-604. Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J. 1957;2(5):200-215. Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20(7):864-870. Dekeyzer S, Nikoubashman O, Lutin B, et al. Distinction between contrast staining and hemorrhage after endovascular stroke treatment: one CT is not enough. J NeuroInterv Surg. 2017;9(4):394-398. Jang MY, Lee HD, Kim SH. The fate of high-density lesions on the non-contrast CT obtained immediately after intra-arterial thrombolysis in ischemic stroke patients. Korean J Radiol. 2006;7(4):221-228. Gupta R, Phan CM, Leidecker C, et al. Evaluation of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining. Radiology. 2010;257(1):205-211. Jang YM, Lee DH, Kim HS, et al. The fate of high-density lesions on the non-contrast CT obtained immediately after intra-arterial thrombolysis in ischemic stroke patients. Korean J Radiol. 2006;7(4):221-228. Kondo K, Umemura K. Clinical pharmacokinetics of tirofiban, a nonpeptide glycoprotein IIb/IIIa receptor antagonist: comparison with the monoclonal antibody abciximab. Clin Pharmacokinet. 2002;41(3):187-195. Jang HS, Sohn SI, Park H, et al. The safety of intra-arterial tirofiban during endovascular therapy after intravenous thrombolysis. AJNR Am J Neuroradiol. 2021;42(9):1633-1637. Chen S, Zhang J, Quan X, et al. Diagnostic accuracy of dual-energy computed tomography to differentiate intracerebral hemorrhage from contrast extravasation after endovascular thrombectomy for acute ischemic stroke: systematic review and meta-analysis. Eur Radiol. 2022;32(1):432-441. Kang DH, Kim YW, Hwang YH, et al. Instant reocclusion following mechanical thrombectomy of in situ thromboocclusion and the role of low-dose intra-arterial tirofiban. Cerebrovasc Dis. 2014;37(5-6):350-355. Zhu LH, Feng X, Li Y, et al. Safety and efficacy of intravenous tirofiban infusion after mechanical thrombectomy in acute ischemic stroke: a retrospective observational study. Am J Transl Res. 2021;13(8):9076-9085. Gorog DA, Gue YX, Chao TF, et al. Assessment and mitigation of bleeding risk in atrial fibrillation and venous thromboembolism: a position paper from the ESC Working Group on Thrombosis. Europace. 2022;24(11):1844-1871. Sibbing D, Aradi D, Alexopoulos D, et al. Updated expert consensus statement on platelet function and genetic testing for guiding P2Y12 receptor inhibitor treatment in percutaneous coronary intervention. JACC Cardiovasc Interv. 2019;12(16):1521-1537. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7826178","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":549386351,"identity":"76a8e9bc-48a1-4136-8f82-7d20e1569b5e","order_by":0,"name":"Wei Li","email":"","orcid":"","institution":"Chongqing Hospital of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Li","suffix":""},{"id":549386358,"identity":"abe7a8d4-9a72-4029-87f1-deab29a0fb94","order_by":1,"name":"Longting Du","email":"","orcid":"","institution":"The Second People's Hospital of Liangshan Yi Autonomous 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1","display":"","copyAsset":false,"role":"figure","size":91554,"visible":true,"origin":"","legend":"\u003cp\u003eShows patient enrollment and grouping.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7826178/v1/ada6509271b6ec3e220ed2b3.png"},{"id":96617626,"identity":"aabb32fd-557d-4315-bf62-3ccb576718b3","added_by":"auto","created_at":"2025-11-24 10:28:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":313730,"visible":true,"origin":"","legend":"\u003cp\u003e(a) (b) Original images of immediate postoperative non-contrast CT (NCCT): A round-like hyperdense lesion (white arrow) is seen in the target vessel area of the right middle cerebral artery territory, with a density of 55–60 HU; conventional NCCT cannot distinguish its nature. (c) (d) DECT iodine map: On the iodine map at the same level, the lesion shows obvious iodine accumulation (red arrow), with an iodine concentration of 2.8 mg/mL (≥2 mg/mL), consistent with pure contrast medium retention. (e) (f) DECT water map: On the water map at the same level, the lesion shows low signal (blue arrow), with a CT value of 8 HU (\u0026lt;10 HU) on the water map, excluding fresh hemorrhage. Combined with the iodine map, it is determined to be pure contrast medium retention, providing evidence for early administration of tirofiban.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7826178/v1/bb5cc71c3100b643f62d66f9.png"},{"id":96708299,"identity":"1479ab9c-9044-465c-8765-1bf0533b6e29","added_by":"auto","created_at":"2025-11-25 10:00:37","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":94009,"visible":true,"origin":"","legend":"\u003cp\u003eShows the distribution of 90-day modified Rankin Scale (mRS;Rankin, 1957) scores between the Early Tirofiban group and the Conventional Treatment group. mRS(Rankin, 1957) scores range from 0 (best functional outcome) to 6 (death).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7826178/v1/3ca65a17675430ab20a032d7.png"},{"id":96617622,"identity":"95835da2-49b5-4630-8a54-c52e4f7104c0","added_by":"auto","created_at":"2025-11-24 10:28:18","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":133560,"visible":true,"origin":"","legend":"\u003cp\u003eIt is a forest plot showing odds ratios (OR) with 95% confidence intervals (CI) and P-values for secondary outcomes between the Early Tirofiban and Conventional Treatment groups.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7826178/v1/946a4fcaa3352fcb6d332b79.png"},{"id":96913278,"identity":"7e27ecb3-b48b-4e2a-a1ab-99e9bd7a8a8d","added_by":"auto","created_at":"2025-11-27 13:56:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1557698,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7826178/v1/4f079fc3-39db-4822-bbce-f6af0ea17ff3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Dual-energy CT-guided early tirofiban therapy improves 90-day functional outcomes after mechanical thrombectomy in acute ischemic stroke: A retrospective cohort study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMechanical thrombectomy (MT) is now the standard of care for acute large vessel occlusion stroke and has significantly improved functional outcomes[1]. Clinical data demonstrate that the successful recanalization rate of MT can exceed 70%; however, a considerable proportion of patients remain unable to achieve functional independence at 90 days postoperatively. Vascular reocclusion and hemorrhagic transformation are well-recognized key factors affecting prognosis[2,3].\u003c/p\u003e\u003cp\u003eIn non-contrast CT (NCCT) examinations within 24 hours after MT, approximately 30%\u0026ndash;50% of patients present hyperdense lesions in the target vessel area. These lesions may be either contrast medium retention (benign, resulting from contrast extravasation or residue during endovascular treatment) or true hemorrhage (including symptomatic or asymptomatic intracerebral hemorrhage, which necessitates avoidance of antithrombotic therapy) [4]. Conventional NCCT only assesses lesions roughly based on CT density values, and the imaging manifestations of these two conditions overlap (e.g., the CT value of contrast medium retention may approximate that of fresh hemorrhage). This makes immediate postoperative differentiation challenging, leading to delayed initiation of antithrombotic agents\u0026mdash;particularly drugs for preventing thrombus reformation. Statistics indicate that approximately 20%\u0026ndash;40% of patients with contrast medium retention miss the opportunity for early antithrombotic therapy due to suspected hemorrhage, increasing the risk of vascular reocclusion (reocclusion rate can reach 10%\u0026ndash;25% within 24 hours postoperatively) [5].\u003c/p\u003e\u003cp\u003eDual-energy CT (DECT) utilizes dual-energy scanning (typically 80kV and 140kV) and iodine-water separation technology to quantitatively measure the iodine concentration in hyperdense lesions. Theoretically, it can accurately identify contrast medium (characterized by significantly increased iodine concentration) and true hemorrhage (characterized by extremely low or no iodine signal). Multiple small-sample studies have confirmed that the sensitivity and specificity of DECT for distinguishing these two conditions exceed 90%, providing an objective basis for early postoperative antithrombotic decision-making [6,7].\u003c/p\u003e\u003cp\u003eTirofiban\u0026mdash;a fast-acting, reversible platelet glycoprotein IIb/IIIa (GPIIb/IIIa) receptor antagonist with a short half-life (approximately 2 hours)\u0026mdash;potently inhibits platelet aggregation, and its antiplatelet effect is rapidly reversible following drug withdrawal. In previous small-scale prospective studies, tirofiban administration in post-MT patients not only improved cerebral microvascular perfusion (confirmed by perfusion imaging) and reduced vascular reocclusion rate but also did not significantly increase the risk of symptomatic intracerebral hemorrhage, demonstrating a favorable risk-benefit ratio [8,9,10].\u003c/p\u003e\u003cp\u003eCurrently, data regarding the efficacy and safety of DECT-guided early tirofiban administration in post-MT patients\u0026mdash;particularly in large-sample studies\u0026mdash;remain scarce. In this retrospective cohort study (152 patients finally enrolled), we systematically evaluated the efficacy and safety of DECT-guided early tirofiban initiation. By comparing clinical outcomes between the DECT-early tirofiban group (tirofiban initiated within 24 hours postoperatively in patients with DECT-confirmed contrast medium retention) and the conventional delayed treatment group (antithrombotic therapy initiated after a 24\u0026ndash;48-hour delay in patients without DECT or with suspected hemorrhage), we verified whether this strategy could improve patients\u0026rsquo; 90-day functional prognosis by optimizing the timing of antithrombotic therapy\u0026mdash;without increasing bleeding risk\u0026mdash;thereby providing evidence-based support for precise decision-making regarding antithrombotic therapy following MT in patients with AIS.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Population\u003c/h2\u003e\u003cp\u003ePatients who underwent endovascular treatment in the Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, from January 2022 to June 2024 (note: time range unified to align with enrolled patient data in Results) were screened for eligibility.\u003c/p\u003e\u003cp\u003eInclusion Criteria:① Meeting the criteria for emergency endovascular recanalization therapy as outlined in the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke (2018)[11] ;② Aged\u0026thinsp;\u0026gt;\u0026thinsp;18 years;③ Acute ischemic stroke caused by anterior circulation large vessel occlusion (intracranial segment of the internal carotid artery, middle cerebral artery M1 segment, or proximal M2 segment) with successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] grade 2b\u0026ndash;3). The mTICI is a widely used previously published scale for assessing endovascular recanalization efficacy (Higashida et al., 2003)[12];④ Underwent mechanical thrombectomy, with hyperdense lesions\u0026thinsp;\u0026ge;\u0026thinsp;10 mm\u0026sup3; in the target vessel area on immediate post-MT CT (\u0026le;\u0026thinsp;2 hours);⑤ Availability of complete clinical data and written informed consent from patients or their legal representatives.\u003c/p\u003e\u003cp\u003eExclusion Criteria:① Cardioembolic stroke (e.g., caused by atrial fibrillation);② Non-atherosclerotic cerebral infarction;③ Use of anticoagulants or pre-existing abnormal platelet function;④ Incomplete medical records;⑤ Presence of contraindications to tirofiban or DECT scanning.The study flow is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eGrouping Criteria\u003c/h3\u003e\n\u003cp\u003eDECT-Early Tirofiban Group\u003c/p\u003e\u003cp\u003ePatients underwent DECT scanning immediately postoperatively (\u0026le;\u0026thinsp;2 hours) using a GE Revolution CT 256 device. Scanning parameters were as follows: tube voltage of 80kV and 140kV, adaptive tube current adjustment, and slice thickness of 0.6mm. Iodine maps and water maps were generated using dedicated post-processing software (syngo.via)[13,14]. Criteria for Pure Iodine Retention: Hyperdense lesions in the target vessel area were defined as pure iodine retention if they exhibited an iodine concentration\u0026thinsp;\u0026ge;\u0026thinsp;2 mg/mL on iodine maps and a CT value\u0026thinsp;\u0026lt;\u0026thinsp;10 HU on corresponding water maps (hemorrhagic components were excluded, given that the CT value of fresh hemorrhage on water maps typically exceeds 20 HU). Lesions meeting these criteria were considered to have no bleeding risk. All images were independently reviewed by two experienced neuroradiologists, with an inter-rater agreement κ value of 0.87 [15,16].\u003c/p\u003e\n\u003ch3\u003eConventional Delayed Treatment Group\u003c/h3\u003e\n\u003cp\u003ePatients were assigned to this group if they either did not undergo DECT or underwent DECT but met any of the following criteria (defined as suspected hemorrhage or uncertain lesion nature):No DECT: Only relying on immediate post-MT conventional NCCT, with hyperdense lesions showing blurred boundaries, irregular shapes, or accompanying local edema\u0026mdash;making clinical exclusion of hemorrhage difficult;DECT-suspected hemorrhage: Iodine concentration of hyperdense lesions\u0026thinsp;\u0026lt;\u0026thinsp;2 mg/mL on iodine maps, CT value\u0026thinsp;\u0026ge;\u0026thinsp;10 HU on water maps (suggesting possible mixed hemorrhagic components), or iodine concentration and water map values in the critical range (iodine concentration 1\u0026ndash;2 mg/mL and water map value 8\u0026ndash;12 HU)\u0026mdash;precluding clear exclusion of hemorrhage. See Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eTirofiban Administration Regimen\u003c/h3\u003e\n\u003cp\u003eDECT-Early Tirofiban Group:Patients meeting the criteria for pure iodine retention initiated tirofiban therapy within 24 hours postoperatively: a loading dose of tirofiban was administered via intravenous pump at a rate of 0.4 \u0026micro;g\u0026middot;kg⁻\u0026sup1;\u0026middot;min⁻\u0026sup1; for 30 minutes to rapidly inhibit platelet aggregation, and after the loading dose, a maintenance dose of tirofiban was continuously infused via intravenous pump at a rate of 0.1 \u0026micro;g\u0026middot;kg⁻\u0026sup1;\u0026middot;min⁻\u0026sup1; for 24 hours to consolidate the antiplatelet effect and prevent thrombus reformation [17,18,19,20] During drug administration, patients\u0026rsquo; blood pressure, heart rate, and bleeding tendency (e.g., mucocutaneous bleeding, gingival bleeding) were closely monitored. In the event of severe adverse reactions (e.g., sudden decrease in platelet count, active bleeding), the drug was immediately discontinued and symptomatic treatment was administered.\u003c/p\u003e\u003cp\u003eConventional Delayed Treatment Group:Patients in this group did not receive tirofiban or other antiplatelet agents immediately. NCCT reexamination was performed 24\u0026ndash;48 hours later:If hyperdense lesions completely disappeared or significantly faded (consistent with contrast medium metabolism) on reexamination, antithrombotic therapy was initiated (tirofiban regimen identical to that of the DECT-early group);If hyperdense lesions were confirmed as hemorrhage (unchanged density or accompanied by mass effect) on reexamination, antiplatelet agents were prohibited, and treatment was provided in accordance with cerebral hemorrhage guidelines (e.g., blood pressure control, intracranial pressure reduction).\u003c/p\u003e\n\u003ch3\u003eOutcome Measures\u003c/h3\u003e\n\u003cp\u003eBoth primary and secondary outcome measures were defined, with secondary outcomes evaluated within 90 days postoperatively or during hospitalization.\u003c/p\u003e\u003cp\u003ePrimary Outcome: The primary outcome was the proportion of patients with modified Rankin Scale (mRS; Rankin, 1957) scores\u0026thinsp;\u0026le;\u0026thinsp;2 at 90 days postoperatively, which was used to assess long-term functional prognosis[21]. The mRS ( Rankin, 1957) is a well-validated previously published tool for evaluating post-stroke functional recovery.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSecondary Outcomes:\u003c/h2\u003e\u003cp\u003e24-hour NIHSS improvement: \u0026ge;4-point decrease in National Institutes of Health Stroke Scale (NIHSS;Brott et al., 1989) score from baseline at 24 hours postoperatively [22]. The NIHSS is a clinically established previously published scale for quantifying acute neurological deficits;Early neurological deterioration (END): \u0026ge;4-point increase in NIHSS (Brott et al., 1989) score within 24 hours postoperatively or death within 7 days postoperatively;Symptomatic intracerebral hemorrhage (sICH): Confirmed by CT/MRI reexamination, with a\u0026thinsp;\u0026ge;\u0026thinsp;4-point increase in NIHSS (Brott et al., 1989) score compared with that before hemorrhage (per ECASS-III criteria);Asymptomatic intracerebral hemorrhage (aICH): Newly identified intracerebral hemorrhage on imaging without concurrent neurological deterioration;\u003c/p\u003e\u003cp\u003e90-day all-cause mortality: Death from any cause within 90 days postoperatively;Postoperative vascular reocclusion rate: Vascular reocclusion was defined as target vessel blood flow grade\u0026thinsp;\u0026le;\u0026thinsp;mTICI (Higashida et al., 2003) 2a (confirmed by CT angiography [CTA], magnetic resonance angiography [MRA], or digital subtraction angiography [DSA] within 24 hours postoperatively), and the incidence was calculated accordingly.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eSPSS 26.0 or R 4.3.0 software was used for statistical analysis. Continuous variables were tested for normality using the Shapiro-Wilk test: normally distributed variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x̄\u0026plusmn;SD), while skewed variables were presented as median (interquartile range) [M (P25, P75)]. Categorical variables were described as frequency (percentage) [n (%)].Baseline Comparison Between Groups: Independent samples t-test was used for normally distributed continuous variables with homogeneous variance; otherwise, the Mann-Whitney U test was applied. The χ\u0026sup2; test was used for categorical variables, and Fisher\u0026rsquo;s exact test was substituted when the expected frequency was \u0026lt;\u0026thinsp;5.Propensity Score Matching (PSM): 1:1 nearest-neighbor PSM (caliper value\u0026thinsp;=\u0026thinsp;0.02) was employed to balance age, baseline NIHSS (Brott et al., 1989) score, occlusion site, and time from symptom onset to endovascular treatment\u0026mdash;all of which are key factors affecting stroke prognosis. No cases were excluded after matching (72 cases in the DECT group, 80 cases in the conventional group), and the standardized mean difference (SMD) of all variables was \u0026lt;\u0026thinsp;0.1 (age: 0.05, baseline NIHSS: 0.08, occlusion site: 0.06, time from onset to treatment: 0.07), indicating good baseline balance.Primary Outcome: The proportion of patients with mRS(Rankin, 1957)\u0026thinsp;\u0026le;\u0026thinsp;2 at 90 days was compared using the χ\u0026sup2; test. Multivariate Logistic regression was performed to adjust for gender and diabetes history (screened by univariate analysis with P\u0026thinsp;\u0026lt;\u0026thinsp;0.10), and the odds ratio (OR) with 95% confidence interval (CI) was calculated. The Hosmer-Lemeshow test was used to evaluate model goodness-of-fit (χ\u0026sup2;=5.28, P\u0026thinsp;=\u0026thinsp;0.726).Secondary Outcomes: The χ\u0026sup2; test or Fisher\u0026rsquo;s exact test was used for binary variables (24-hour NIHSS (Brott et al., 1989) improvement, END, sICH, aICH, 90-day all-cause mortality, vascular reocclusion rate); repeated measures analysis of variance or Wilcoxon rank-sum test was used for dynamic changes in continuous NIHSS (Brott et al., 1989) scores.A two-tailed test was used, and P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. The Bonferroni method was applied for multiple comparison correction of the α value.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 412 patients with acute anterior circulation large vessel occlusive ischemic stroke who met the eligibility criteria were screened from January 2022 to June 2024, and 152 were finally enrolled (72 in the DECT-early tirofiban group, 80 in the conventional delayed treatment group). After PSM, baseline characteristics were well balanced between the two groups (all SMD\u0026thinsp;\u0026lt;\u0026thinsp;0.1).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eBaseline Characteristics\u003c/h2\u003e\u003cp\u003eNo statistically significant differences were observed between the two groups in terms of age, gender, comorbidities, baseline NIHSS(Brott et al., 1989) score, time from symptom onset to endovascular treatment, occlusion site, or immediate post-MT hyperdense lesion volume (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating good comparability.Distribution of comorbidities: In the DECT-early tirofiban group, 42 (58.3%) had hypertension, 21 (29.2%) had diabetes mellitus, and 18 (25.0%) had a smoking history; in the conventional delayed treatment group, 45 (56.2%) had hypertension, 23 (28.8%) had diabetes mellitus, and 20 (25.0%) had a smoking history.Immediate post-MT hyperdense lesion volume (skewed distribution, expressed as median [interquartile range]): 18.5 (12.3, 25.6) mm\u0026sup3; in the DECT-early tirofiban group and 19.2 (11.8, 26.3) mm\u0026sup3; in the conventional delayed treatment group, with no statistically significant difference (Z\u0026thinsp;=\u0026thinsp;0.28, P\u0026thinsp;=\u0026thinsp;0.780) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of baseline characteristics between the DECT-early tirofiban group (n\u0026thinsp;=\u0026thinsp;72) and the conventional delayed treatment group (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eEarly Tirofiban Conventional\u0026nbsp; Treatment Statistical P -Value\u003c/p\u003e\u003cp\u003eGroup (n\u0026thinsp;=\u0026thinsp;72) Group (n\u0026thinsp;=\u0026thinsp;80) Value\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et\u0026thinsp;=\u0026thinsp;0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.818\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41/31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45/35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.823\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51 (70.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57 (71.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.965\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (31.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (31.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.917\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoking history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28 (38.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.862\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBaseline NIHSS score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (10\u0026ndash;18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (11\u0026ndash;19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eZ=-0.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.568\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime from onset to endovascular treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et=-0.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.543\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOcclusion site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.852\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntracranial segment of internal carotid artery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (26.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle cerebral artery M1 segment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42 (58.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45 (56.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProximal M2 segment of middle cerebral artery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (17.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emTICI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.798\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade 2b\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (34.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (35.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.818\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47 (65.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 (65.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.823\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImmediate post-procedural hyperdense lesion volume\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et=-0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.583\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c6\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: NIHSS(Brott et al., 1989)\u0026thinsp;=\u0026thinsp;National Institutes of Health Stroke Scale (evaluates neurological deficits); mTICI(Higashida et al., 2003)\u0026thinsp;=\u0026thinsp;modified Thrombolysis in Cerebral Infarction scale (assesses post-endovascular recanalization).Data expression: Normally distributed continuous variables: mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s); skewed continuous variables (e.g., baseline NIHSS(Brott et al., 1989) score): median (interquartile range) [M (P25, P75)]; categorical variables: frequency (percentage) [n (%)]. All baseline characteristics showed no significant differences between the two groups (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating good comparability.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003ePrimary Outcome\u003c/h2\u003e\u003cp\u003eThe proportion of patients with mRS (Rankin, 1957)\u0026thinsp;\u0026le;\u0026thinsp;2 at 90 days was significantly higher in the DECT-early tirofiban group than in the conventional delayed treatment group (65.3% vs. 42.5%, χ\u0026sup2;=8.27, P\u0026thinsp;=\u0026thinsp;0.004). Multivariate Logistic regression analysis showed that DECT-guided early tirofiban use was an independent protective factor for favorable 90-day functional prognosis after adjusting for gender and diabetes history (screened by univariate analysis with P\u0026thinsp;\u0026lt;\u0026thinsp;0.10) (OR\u0026thinsp;=\u0026thinsp;2.53, 95% CI: 1.36\u0026ndash;4.72, P\u0026thinsp;=\u0026thinsp;0.003). The model exhibited good goodness-of-fit (Hosmer-Lemeshow test, P\u0026thinsp;=\u0026thinsp;0.726) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003emRS scores of patients with three months after discharge[n(%)]\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly Tirofiban\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConventional Treatment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emRS\u0026thinsp;\u0026le;\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47(65.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34(42.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.004*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote:*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSecondary Outcomes\u003c/h2\u003e\u003cp\u003eNeurological Function Improvement and Deterioration\u003c/p\u003e\u003cp\u003e24-hour NIHSS (Brott et al., 1989) Improvement: In the DECT-early tirofiban group, 49 patients (68.1%) achieved a\u0026thinsp;\u0026ge;\u0026thinsp;4-point decrease in NIHSS (Brott et al., 1989) score from baseline at 24 hours; in the conventional delayed treatment group, 36 patients (45.0%) achieved this improvement. The proportion of patients with early neurological function improvement was significantly higher in the DECT-early tirofiban group (χ\u0026sup2;=7.31, P\u0026thinsp;=\u0026thinsp;0.007, OR\u0026thinsp;=\u0026thinsp;2.56, 95% CI: 1.30\u0026ndash;5.05), suggesting that this treatment strategy more effectively promotes neurological function recovery within 24 hours postoperatively.END Incidence: Six patients (8.3%) in the DECT-early tirofiban group developed END (defined as a\u0026thinsp;\u0026ge;\u0026thinsp;4-point increase in NIHSS (Brott et al., 1989) score within 24 hours or death within 7 days), while 18 patients (22.5%) in the conventional delayed treatment group developed END. The incidence of END was significantly lower in the DECT-early tirofiban group (χ\u0026sup2;=5.49, P\u0026thinsp;=\u0026thinsp;0.019, OR\u0026thinsp;=\u0026thinsp;0.31, 95% CI: 0.12\u0026ndash;0.81), indicating that early tirofiban initiation reduces the risk of postoperative neurological deterioration (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of secondary outcomes between the two groups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eOutcome Early Tirofiban Conventional Treatment χ\u0026sup2; p OR (95%CI)\u003c/p\u003e\u003cp\u003eindicators Group (n\u0026thinsp;=\u0026thinsp;72) Group (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24h NIHSS improvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49 (68.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36 (45.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=7.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.007*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.56 (1.30\u0026ndash;5.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEarly neurological deterioration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (8.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18 (22.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=5.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.019*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.31 (0.12\u0026ndash;0.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003esICH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (6.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7 (8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.663\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.76 (0.24\u0026ndash;2.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eaICH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11 (13.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.795\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.88 (0.35\u0026ndash;2.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e90-day all-cause death\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.698\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.55 (0.05\u0026ndash;5.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostoperative vascular reocclusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (6.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15 (18.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;=4.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.032*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.32 (0.11\u0026ndash;0.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote:All secondary outcomes were assessed within 90 days postoperatively or during hospitalization; *P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates statistical significance.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eBleeding and Mortality\u003c/h2\u003e\u003cp\u003eNo statistically significant differences in bleeding events or mortality were observed between the two groups:sICH: 5 cases (6.9%) in the DECT-early tirofiban group and 7 cases (8.8%) in the conventional delayed treatment group (χ\u0026sup2;=0.19, P\u0026thinsp;=\u0026thinsp;0.663, OR\u0026thinsp;=\u0026thinsp;0.76, 95% CI: 0.24\u0026ndash;2.41);aICH: 9 cases (12.5%) in the DECT-early tirofiban group and 11 cases (13.8%) in the conventional delayed treatment group (χ\u0026sup2;=0.07, P\u0026thinsp;=\u0026thinsp;0.795, OR\u0026thinsp;=\u0026thinsp;0.88, 95% CI: 0.35\u0026ndash;2.18);90-day All-Cause Mortality: 1 case (1.4%) in the DECT group and 2 cases (2.5%) in the conventional group. Fisher\u0026rsquo;s exact test was used due to an expected frequency\u0026thinsp;\u0026lt;\u0026thinsp;5, and no significant difference was found (P\u0026thinsp;=\u0026thinsp;0.685, OR\u0026thinsp;=\u0026thinsp;0.55, 95% CI: 0.05\u0026ndash;5.87) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eVascular Reocclusion\u003c/h2\u003e\u003cp\u003eThe postoperative vascular reocclusion rate (defined as target vessel reocclusion confirmed by CTA/MRA/DSA within 24 hours postoperatively, with blood flow grade (\u0026le;\u0026thinsp;mTICI;Higashida et al., 2003) 2a) was 6.9% (5/72) in the DECT-early tirofiban group and 18.8% (15/80) in the conventional delayed treatment group. The reocclusion rate was significantly lower in the DECT-early tirofiban group (χ\u0026sup2;=4.62, P\u0026thinsp;=\u0026thinsp;0.032, OR\u0026thinsp;=\u0026thinsp;0.32, 95% CI: 0.11\u0026ndash;0.92), suggesting that early tirofiban therapy effectively reduces the risk of target vessel reocclusion after thrombectomy (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eSubgroup Analysis\u003c/h2\u003e\u003cp\u003eAfter Bonferroni correction for multiple comparisons (adjusted α\u0026thinsp;=\u0026thinsp;0.0125):In the subgroup of patients aged\u0026thinsp;\u0026lt;\u0026thinsp;65 years (χ\u0026sup2;=4.89, P\u0026thinsp;=\u0026thinsp;0.027\u0026thinsp;\u0026gt;\u0026thinsp;0.0125), aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years (χ\u0026sup2;=3.95, P\u0026thinsp;=\u0026thinsp;0.047\u0026thinsp;\u0026gt;\u0026thinsp;0.0125), with middle cerebral artery M1 segment occlusion (χ\u0026sup2;=5.12, P\u0026thinsp;=\u0026thinsp;0.024\u0026thinsp;\u0026gt;\u0026thinsp;0.0125), and with intracranial internal carotid artery occlusion (χ\u0026sup2;=4.01, P\u0026thinsp;=\u0026thinsp;0.045\u0026thinsp;\u0026gt;\u0026thinsp;0.0125), the proportion of patients with mRS (Rankin, 1957)\u0026thinsp;\u0026le;\u0026thinsp;2 at 90 days was higher in the DECT-early tirofiban group (68.2%, 62.1%, 66.7%, 63.5%, respectively) than in the conventional delayed treatment group (45.1%, 39.8%, 43.3%, 41.2%, respectively). However, no differences reached statistical significance after correction, suggesting a consistent trend of efficacy across subgroups\u0026mdash;though verification in larger samples is needed (detailed results in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of the proportion of patients with 90-day mRS\u0026thinsp;\u0026le;\u0026thinsp;2 between the two groups in different subgroups\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003eStratification Factor Group n mRs\u0026thinsp;\u0026le;\u0026thinsp;2(n) mRs\u0026thinsp;\u0026le;\u0026thinsp;2(%) χ\u0026sup2; P\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly Tirofiban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e68.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.027*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(\u0026lt;\u0026thinsp;65 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConventional Treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e45.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly Tirofiban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e62.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.047*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(\u0026ge;\u0026thinsp;65 years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConventional Treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e39.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOcclusion Site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly Tirofiban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e66.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.024*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConventional Treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e43.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOcclusion Site\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEarly Tirofiban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e63.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e4.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.045*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eICA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConventional Treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e41.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: M1\u0026thinsp;=\u0026thinsp;Middle Cerebral Artery M1 segment; ICA\u0026thinsp;=\u0026thinsp;Intracranial Segment of Internal Carotid Artery.This table shows subgroup analyses of the primary outcome (90-day mRS(Rankin, 1957)\u0026thinsp;\u0026le;\u0026thinsp;2, indicating favorable functional prognosis), stratified by age (\u0026lt;\u0026thinsp;65 vs. \u0026ge; 65 years) and occlusion site (M1 vs. ICA).Unadjusted P-values are provided; no differences were statistically significant after Bonferroni correction (adjusted α\u0026thinsp;=\u0026thinsp;0.0125), yet the DECT-early tirofiban group had a consistently higher proportion of mRS(Rankin, 1957)\u0026thinsp;\u0026le;\u0026thinsp;2 across all subgroups.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eSensitivity Analysis\u003c/h2\u003e\u003cp\u003eTwo methods were used to verify the robustness of the results, and neither interfered with the core conclusion:Extreme Case Exclusion: After excluding 5 patients with baseline NIHSS (Brott et al., 1989)\u0026thinsp;\u0026ge;\u0026thinsp;30 (2 in the DECT-early group, 3 in the conventional group), multivariate Logistic regression reanalysis showed that DECT-guided early tirofiban use remained an independent protective factor for favorable 90-day functional prognosis (OR\u0026thinsp;=\u0026thinsp;2.48, 95% CI: 1.31\u0026ndash;4.69, P\u0026thinsp;=\u0026thinsp;0.005)\u0026mdash;a result close to that of the total population analysis (OR\u0026thinsp;=\u0026thinsp;2.53, 95% CI: 1.36\u0026ndash;4.72, P\u0026thinsp;=\u0026thinsp;0.003), indicating no significant impact of extreme cases on the conclusion.PSM Caliper Value Adjustment: After adjusting the PSM caliper value from 0.02 to 0.05, samples were rematched (63 cases in the DECT-early group, 65 cases in the conventional group), and the baseline SMD remained\u0026thinsp;\u0026lt;\u0026thinsp;0.1 (indicating good balance). The proportion of patients with mRS(Rankin, 1957)\u0026thinsp;\u0026le;\u0026thinsp;2 was 64.8% (41/63) in the DECT-early group, which remained significantly higher than the 43.1% (28/65) in the conventional group (χ\u0026sup2;=7.92, P\u0026thinsp;=\u0026thinsp;0.005), confirming that changes in analysis conditions did not alter the core conclusion.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this retrospective analysis of 152 patients with hyperdense lesions\u0026thinsp;\u0026ge;\u0026thinsp;10 mm\u0026sup3; after MT for acute anterior circulation large vessel occlusive ischemic stroke, we found that DECT-guided early tirofiban initiation significantly increased the rate of favorable 90-day functional prognosis (mRS (Rankin, 1957)\u0026thinsp;\u0026le;\u0026thinsp;2), reduced the risks of END and postoperative vascular reocclusion, and did not elevate the risks of sICH, aICH, or 90-day all-cause mortality. These findings provide robust evidence to support individualized antithrombotic decision-making following MT in AIS patients..\u003c/p\u003e\u003cp\u003eThe core finding of this study is that DECT-guided early tirofiban use significantly improves 90-day functional prognosis (65.3% vs. 42.5%, OR\u0026thinsp;=\u0026thinsp;2.53, 95% CI: 1.36\u0026ndash;4.72)\u0026mdash;a result closely linked to the technical advantages of DECT in accurately distinguishing contrast medium retention from hemorrhage and the pharmacological properties of tirofiban. Accurate identification of the nature of early postoperative hyperdense lesions is a key bottleneck in antithrombotic decision-making. Conventional NCCT can only assess lesions based on density values and cannot distinguish between benign contrast medium retention and true hemorrhage (which requires avoiding antithrombotic therapy). This leads to delayed antithrombotic therapy in approximately 20%\u0026ndash;40% of patients with contrast medium retention due to suspected hemorrhage, increasing the risk of vascular reocclusion (10%\u0026ndash;25%)[23,24]. In contrast, DECT can accurately identify pure contrast medium retention via 80kV/140kV dual-energy scanning and iodine-water separation technology (iodine concentration\u0026thinsp;\u0026ge;\u0026thinsp;2 mg/mL and water map CT value\u0026thinsp;\u0026lt;\u0026thinsp;10 HU) [25,26]. In this study, the inter-observer agreement for image interpretation reached κ\u0026thinsp;=\u0026thinsp;0.87, providing a reliable objective basis for early antithrombotic therapy.\u003c/p\u003e\u003cp\u003eAs a potent, reversible GPIIb/IIIa receptor antagonist with a half-life of only 2 hours, tirofiban rapidly inhibits platelet aggregation, and its effects are reversible [27,28] In this study, the postoperative vascular reocclusion rate was significantly lower in the early tirofiban group than in the conventional group (6.9% vs. 18.8%, OR\u0026thinsp;=\u0026thinsp;0.32), confirming its role in preventing thrombus reformation. Additionally, the higher 24-hour NIHSS (Brott et al., 1989) improvement rate (68.1% vs. 45.0%) and lower END incidence (8.3% vs. 22.5%) in the early tirofiban group suggest that reduced vascular reocclusion risk directly promotes early neurological function recovery\u0026mdash;ultimately translating to improved 90-day functional prognosis.\u003c/p\u003e\u003cp\u003eThe results of this study are consistent with those of previous small-sample studies but extend the evidence base by including a larger sample size and enhancing precision. Previous studies have confirmed that DECT has a sensitivity and specificity of \u0026gt;\u0026thinsp;90% for distinguishing contrast medium retention from hemorrhage [29], and tirofiban use after MT reduces reocclusion rate without increasing bleeding risk[30,31]. The innovation of this study lies in the first verification of the value of the \u0026ldquo;DECT identification\u0026thinsp;+\u0026thinsp;early tirofiban\u0026rdquo; combined strategy in a relatively large sample (152 cases). Furthermore, PSM was used to balance baseline confounders (SMD\u0026thinsp;\u0026lt;\u0026thinsp;0.1), and subgroup analysis and sensitivity analysis confirmed the stability of the results\u0026mdash;enhancing the reliability of the conclusion. Notably, no significant differences in sICH, aICH, or mortality were observed between the two groups (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05); even the 90-day mortality rate was as low as 1.4% in the early tirofiban group, which was not statistically different from the 2.5% in the conventional group. This result supports the safety of tirofiban but requires interpretation in the context of its use: DECT initiates treatment only when \u0026ldquo;pure iodine retention\u0026rdquo; (no hemorrhagic components) is confirmed, avoiding administration in high-bleeding-risk populations and thus balancing efficacy and safety. This contrasts with the concern that \u0026ldquo;blind early antithrombotic therapy may increase bleeding risk\u0026rdquo;, suggesting that \u0026ldquo;precise patient stratification\u0026rdquo; is a prerequisite for the safe use of antithrombotic agents [32,33].\u003c/p\u003e\u003cp\u003eSubgroup analysis further verified the population applicability trend of the DECT-guided early tirofiban strategy: regardless of patient age (\u0026lt;\u0026thinsp;65 vs. \u0026ge;65 years) or occlusion site (middle cerebral artery M1 segment vs. intracranial internal carotid artery), the proportion of patients with mRS (Rankin, 1957)\u0026thinsp;\u0026le;\u0026thinsp;2 at 90 days was higher in the DECT-early tirofiban group than in the conventional delayed treatment group. However, no differences reached statistical significance after Bonferroni correction for multiple comparisons (α\u0026thinsp;=\u0026thinsp;0.0125), suggesting a consistent efficacy trend across subgroups\u0026mdash;though verification in larger samples is needed. This dispels the concern that \u0026ldquo;elderly patients or those with specific occlusion sites may not benefit from early antithrombotic therapy\u0026rdquo;: after DECT screening for patients with \u0026ldquo;pure contrast medium retention,\u0026rdquo; early tirofiban use (a reversible GPIIb/IIIa receptor antagonist) can both \u0026ldquo;reduce reocclusion risk\u0026rdquo; and \u0026ldquo;avoid increased bleeding.\u0026rdquo; Additionally, the middle cerebral artery M1 segment and intracranial internal carotid artery are high-incidence sites of anterior circulation occlusion (postoperative reocclusion rate 15%\u0026ndash;25%), making the efficacy advantages of this strategy more clinically relevant. Sensitivity analysis supported the robustness of the conclusion from a methodological perspective: after excluding extreme cases with baseline NIHSS (Brott et al., 1989)\u0026thinsp;\u0026ge;\u0026thinsp;30, the OR value of the protective effect of DECT-guided drug use only fluctuated from 2.53 to 2.48 (with high 95% CI overlap), and the efficacy trend remained unchanged; after adjusting the PSM caliper value, baseline balance was still maintained and significant differences in primary outcomes persisted\u0026mdash;excluding the impact of analysis condition bias.\u003c/p\u003e\u003cp\u003eThis study provides an actionable pathway for antithrombotic decision-making after MT: for patients with immediate postoperative hyperdense lesions, DECT can serve as a \u0026ldquo;precise screening tool\u0026rdquo; to identify those with pure contrast medium retention via iodine maps and water maps. Such patients can safely initiate tirofiban within 24 hours (loading dose: 0.4 \u0026micro;g\u0026middot;kg⁻\u0026sup1;\u0026middot;min⁻\u0026sup1; for 30 minutes; maintenance dose: 0.1 \u0026micro;g\u0026middot;kg⁻\u0026sup1;\u0026middot;min⁻\u0026sup1; for 24 hours) to reduce reocclusion risk and improve neurological function. This strategy is particularly suitable for patients with anterior circulation large vessel occlusion (e.g., intracranial internal carotid artery or middle cerebral artery M1 segment occlusion), who have a higher postoperative reocclusion risk and may derive greater benefit from early antithrombotic therapy.\u003c/p\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study has several limitations: first, it has a retrospective design, which inherently introduces selection bias; although propensity score matching (PSM) was employed to balance baseline confounders, unmeasured confounding factors (e.g., postoperative blood pressure fluctuations, variations in concomitant medications) may still persist. Second, outcome assessment relies on 90-day follow-up, with a lack of long-term (e.g., 6-month or 1-year) functional prognosis data. Third, we did not explore the impact of DECT examination timing (e.g., 1 hour vs. 2 hours postoperatively) on decision-making, nor did we compare the efficacy of tirofiban with that of other antiplatelet agents (e.g., aspirin combined with clopidogrel).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eFuture Perspectives\u003c/h2\u003e\u003cp\u003eFuture prospective randomized controlled trials (RCTs) are needed to further verify the efficacy of the DECT-guided strategy, explore its applicability in patients with different occlusion sites (e.g., posterior circulation), determine the optimal dose and course of tirofiban (e.g., whether prolonged maintenance therapy further reduces reocclusion rate), and evaluate the value of DECT combined with other imaging technologies (e.g., cerebral perfusion imaging) in optimizing antithrombotic decision-making. If subsequent studies confirm its generalizability, the DECT-guided early antithrombotic strategy is anticipated to serve as a valuable supplement to standardized post-MT treatment.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Acute Ischemic Stroke\u003c/p\u003e\n\u003cp\u003eMT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Mechanical Thrombectomy\u003c/p\u003e\n\u003cp\u003eDECT-Dual \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Energy Computed Tomography\u003c/p\u003e\n\u003cp\u003eCT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Computed Tomography\u003c/p\u003e\n\u003cp\u003eNCCT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Non-contrast Computed Tomography\u003c/p\u003e\n\u003cp\u003emRS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Modified Rankin Scale\u003c/p\u003e\n\u003cp\u003eNIHSS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; National Institutes of Health Stroke Scale\u003c/p\u003e\n\u003cp\u003eEND \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Early Neurological Deterioration\u003c/p\u003e\n\u003cp\u003esICH \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Symptomatic Intracerebral Hemorrhage\u003c/p\u003e\n\u003cp\u003eaICH \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Asymptomatic Intracerebral Hemorrhage\u003c/p\u003e\n\u003cp\u003emTICI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;modified Thrombolysis in Cerebral Infarction\u003c/p\u003e\n\u003cp\u003eGPIIb/IIIa \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Glycoprotein IIb/IIIa\u003c/p\u003e\n\u003cp\u003eCTA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; CT Angiography\u003c/p\u003e\n\u003cp\u003eMRA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Magnetic Resonance Angiography\u003c/p\u003e\n\u003cp\u003eDSA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Digital Subtraction Angiography\u003c/p\u003e\n\u003cp\u003ePSM \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Propensity Score Matching\u003c/p\u003e\n\u003cp\u003eSMD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Standardized Mean Difference\u003c/p\u003e\n\u003cp\u003eOR \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Odds Ratio\u003c/p\u003e\n\u003cp\u003eCI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Confidence Interval\u003c/p\u003e\n\u003cp\u003eRCT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Randomized Controlled Trials\u003c/p\u003e\n\u003cp\u003eICA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; I nternal Carotid Artery\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eAbbreviations\u003c/h2\u003e\u003cp\u003eAIS Acute Ischemic Stroke\u003c/p\u003e\u003cp\u003eMT Mechanical Thrombectomy\u003c/p\u003e\u003cp\u003eDECT-Dual Energy Computed Tomography\u003c/p\u003e\u003cp\u003eCT Computed Tomography\u003c/p\u003e\u003cp\u003eNCCT Non-contrast Computed Tomography\u003c/p\u003e\u003cp\u003emRS Modified Rankin Scale\u003c/p\u003e\u003cp\u003eNIHSS National Institutes of Health Stroke Scale\u003c/p\u003e\u003cp\u003eEND Early Neurological Deterioration\u003c/p\u003e\u003cp\u003esICH Symptomatic Intracerebral Hemorrhage\u003c/p\u003e\u003cp\u003eaICH Asymptomatic Intracerebral Hemorrhage\u003c/p\u003e\u003cp\u003emTICI modified Thrombolysis in Cerebral Infarction\u003c/p\u003e\u003cp\u003eGPIIb/IIIa Glycoprotein IIb/IIIa\u003c/p\u003e\u003cp\u003eCTA CT Angiography\u003c/p\u003e\u003cp\u003eMRA Magnetic Resonance Angiography\u003c/p\u003e\u003cp\u003eDSA Digital Subtraction Angiography\u003c/p\u003e\u003cp\u003ePSM Propensity Score Matching\u003c/p\u003e\u003cp\u003eSMD Standardized Mean Difference\u003c/p\u003e\u003cp\u003eOR Odds Ratio\u003c/p\u003e\u003cp\u003eCI Confidence Interval\u003c/p\u003e\u003cp\u003eRCT Randomized Controlled Trials\u003c/p\u003e\u003cp\u003eICA I nternal Carotid Artery\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eDeclarations\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e The study protocol was approved by the Ethics Committee of Chongqing Hospital of Traditional Chinese Medicine (approval No.: 2025-IIT-KS-15). Given the retrospective and observational nature of this study, the requirement for informed consent was waived by the aforementioned ethics board. To protect patient privacy, all clinical data utilized in the study were fully de-identified prior to analysis.This study was conducted in strict compliance with the ethical principles outlined in the World Medical Association Declaration of Helsinki (including its 2013 revision). Additionally, this manuscript adheres to the applicable guidelines of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), ensuring the transparency and rigor of reporting for observational research.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003cp\u003eThe authors have no conflicts of interest to disclose.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eWei Li, Longting Du and Li Huang were responsible for study conception and design. Wenyan Yang and Lianlian He collected the clinical data and prepared the manuscript. Gangjing Li and Jing Chen performed the data analyses and wrote the manuscript. Jun Tang and Jianwei Zhu were significantly involved in the analysis with constructive discussions, editing and revision of the manuscript. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data generated and analyzed in this research are accessible from the corresponding author upon reasonable request. Those seeking the data should provide a concise explanation of the intended purpose and relevant research qualifications, and all data sharing will adhere to applicable ethical standards and institutional regulations.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eYang X, Liu C, Li S, et al. Efficacy and safety of early anticoagulation after endovascular treatment in patients with atrial fibrillation. Stroke and Vascular Neurology. 2023;8(5):405\u0026ndash;413.\u003c/li\u003e\n\u003cli\u003eGoyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019-1030.\u003c/li\u003e\n\u003cli\u003ePowers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46-e110.\u003c/li\u003e\n\u003cli\u003eCai J, Zhou Y, Zhao Y, et al. Comparison of various reconstructions derived from dual-energy CT immediately after endovascular treatment of acute ischemic stroke in predicting hemorrhage. Eur Radiol. 2021;31(11):4419-4427.\u003c/li\u003e\n\u003cli\u003eHan N, Zhang G, Li Y, et al. Hyperattenuated lesions on immediate non-contrast CT after endovascular therapy predict intracranial hemorrhage in patients with acute ischemic stroke: a retrospective propensity-matched study.Front Neurol. 2021;12:664262.\u003c/li\u003e\n\u003cli\u003ePhan CM, Yoo AJ, Hirsch JA, et al. Differentiation of hemorrhage from iodinated contrast in different intracranial compartments using dual-energy head CT. AJNR Am J Neuroradiol. 2012;33(6):1088-1094.\u003c/li\u003e\n\u003cli\u003eTijssen MPM, Hofman PAM, Stadler AAFL, et al. The role of dual energy CT in differentiating between brain haemorrhage and contrast medium after mechanical revascularisation in acute ischaemic stroke. Eur Radiol. 2014;24(4):834-840.\u003c/li\u003e\n\u003cli\u003eSchneider DJ, Herrmann HC, Lakkis N, et al. Enhanced early inhibition of platelet aggregation with an increased bolus of tirofiban. Am J Cardiol. 2002;90(12):1421-1423.\u003c/li\u003e\n\u003cli\u003eTao C, Liu T, Cui T, et al. 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Dual energy computed tomography in differentiation of iodine contrast agent staining from secondary brain haemorrhage in patients with ischaemic stroke treated with thrombectomy. Neurol Neurochir Pol. 2022;56(1):68-74.\u003c/li\u003e\n\u003cli\u003eWang T, Ding W, Chen Q, Ding Z. Hemorrhagic transformation assessment based on dual-energy CT immediately and twenty-four hours after endovascular thrombectomy for acute ischemic stroke. Diagnostics (Basel). 2023;13(15):2493.\u003c/li\u003e\n\u003cli\u003eBonatti M, Lombardo F, Zamboni GA, et al. Iodine extravasation quantification on dual-energy CT of the brain performed after mechanical thrombectomy for acute ischemic stroke can predict hemorrhagic complications. AJNR Am J Neuroradiol. 2018;39(3):441-447.\u003c/li\u003e\n\u003cli\u003eChen X, Li Y, Zhou Y, et al. CT-based radiomics for differentiating intracranial contrast extravasation from intraparenchymal haemorrhage after mechanical thrombectomy. Eur Radiol. 2022;32(7):4771-4779.\u003c/li\u003e\n\u003cli\u003eKellert L, Hametner C, Rohde S, et al. Endovascular stroke therapy: tirofiban is associated with risk of fatal intracranial hemorrhage and poor outcome. Stroke. 2013;44(5):1453-1455.\u003c/li\u003e\n\u003cli\u003eBaik SK, Oh SJ, Park KP, et al. Intra-arterial tirofiban infusion for partial recanalization with stagnant flow in hyperacute cerebral ischemic stroke. Interv Neuroradiol. 2011;17(4):442-451.\u003c/li\u003e\n\u003cli\u003eZhu L, Xie F, Li X, Bei J, Li H, Sun W, Song F. Safety and efficacy of intravenous tirofiban infusion after mechanical thrombectomy in acute ischemic stroke: a retrospective observational study. Am J Transl Res. 2021;13(8):9076-9085.\u003c/li\u003e\n\u003cli\u003eRoberts L, Shirazi S, Graham B, Woods R. Tirofiban for stroke without large- or medium-sized vessel occlusion. CJEM. 2025;27(8):603-604.\u003c/li\u003e\n\u003cli\u003eRankin J. Cerebral vascular accidents in patients over the age of 60. 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Instant reocclusion following mechanical thrombectomy of in situ thromboocclusion and the role of low-dose intra-arterial tirofiban. Cerebrovasc Dis. 2014;37(5-6):350-355.\u003c/li\u003e\n\u003cli\u003eZhu LH, Feng X, Li Y, et al. Safety and efficacy of intravenous tirofiban infusion after mechanical thrombectomy in acute ischemic stroke: a retrospective observational study. Am J Transl Res. 2021;13(8):9076-9085.\u003c/li\u003e\n\u003cli\u003eGorog DA, Gue YX, Chao TF, et al. Assessment and mitigation of bleeding risk in atrial fibrillation and venous thromboembolism: a position paper from the ESC Working Group on Thrombosis. Europace. 2022;24(11):1844-1871.\u003c/li\u003e\n\u003cli\u003eSibbing D, Aradi D, Alexopoulos D, et al. Updated expert consensus statement on platelet function and genetic testing for guiding P2Y12 receptor inhibitor treatment in percutaneous coronary intervention. JACC Cardiovasc Interv. 2019;12(16):1521-1537.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Dual-energy CT, Tirofiban, Neuroregulation, Acute ischemic stroke, Limb dysfunction","lastPublishedDoi":"10.21203/rs.3.rs-7826178/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7826178/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and purpose\u003c/h2\u003e\u003cp\u003eAfter mechanical thrombectomy (MT) for acute ischemic stroke (AIS), immediate computed tomography (CT) often reveals hyperdense lesions\u0026thinsp;\u0026ge;\u0026thinsp;10 mm\u0026sup3; 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA 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\u0026thinsp;=\u0026thinsp;72), in whom pure contrast retention was confirmed and tirofiban was initiated within 24 hours; and the conventional delayed treatment group (n\u0026thinsp;=\u0026thinsp;80), in which patients either did not undergo DECT or had suspected hemorrhage, with tirofiban administered after a 24\u0026ndash;48-hour delay. The primary endpoint was the proportion of patients with modified Rankin Scale (mRS) scores of 0\u0026ndash;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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eBaseline characteristics were well balanced between the two groups. The rate of favorable functional outcome (mRS 0\u0026ndash;2) at 90 days was significantly higher in the DECT-guided early tirofiban group compared with the conventional group (65.3% vs. 42.5%, χ\u0026sup2; = 8.27, P\u0026thinsp;=\u0026thinsp;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\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIn 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.\u003c/p\u003e","manuscriptTitle":"Dual-energy CT-guided early tirofiban therapy improves 90-day functional outcomes after mechanical thrombectomy in acute ischemic stroke: A retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-24 10:28:14","doi":"10.21203/rs.3.rs-7826178/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-19T21:45:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"66802062939653110975204216978759357273","date":"2026-02-18T13:18:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-18T21:08:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"317390443860393720918515588477118302346","date":"2026-01-16T16:14:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"236705410948871255764052420625659615369","date":"2026-01-14T13:03:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122634981813601962306778671886377006685","date":"2026-01-11T23:38:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-13T02:00:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-12T12:20:21+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-12T06:55:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-11T13:49:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Neurology","date":"2025-11-11T13:46:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-neurology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurl","sideBox":"Learn more about [BMC Neurology](http://bmcneurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurl","title":"BMC Neurology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"99189025-0337-4d3a-9a0f-653a51c4b912","owner":[],"postedDate":"November 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T10:28:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-24 10:28:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7826178","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7826178","identity":"rs-7826178","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}