ESOC 2026 | The ATILA trial: low-dose tirofiban in AIS due to tandem lesions undergoing mechanical thrombectomy

The ATILA trial was a multi-center randomized clinical trial about safety and efficacy of low-dose tirofiban in acute ischemic stroke due to tandem occlusion undergoing mechanical thrombectomy plus carotid stenting. The trial was conducted in 13 centers in Spain and the randomization was between aspirin and tirofiban in the patients after stenting. And the key results were that tirofiban plus carotid stent was effective for carotid reocclusion and with an optimal safety profile without differences in the functional outcome. But at last, it looks like the main outcomes were achieved in the trial. The main efficacy outcome was carotid rare occlusion within the first 24 hours after randomization and symptomatic intracranial hemorrhage of these 24 hours. And the secondary outcomes were rescue treatment during the endovascular procedure and functional outcome at three months. Well, the main adverse event was the symptomatic intracranial hemorrhage, which was the main safety outcome. Regarding the other adverse events, it was the regular one in this acute setting stroke kind of trial, but there were no differences between the two arms in the trial. I think that the main message is that tirofiban plus carotid stent works for carotid reocclusion and with an optimal safety profile. Maybe we need another trial to relate this reocclusion with functional outcome. But I think that this could change the approach of these tandem occlusion patients and more of that is the first evidence in this kind of patient. So I think that this could be changed.

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