ATILA
(2026)Objective
Phase IV PROBE superiority trial comparing peri-procedural tirofiban vs IV ASA in patients undergoing emergent carotid artery stenting (eCAS) during EVT for tandem lesions.
Study Summary
• Primary carotid reocclusion at 24h: 7.2% vs 16.8% (P=0.036), NNT=10.4.
• Intra-stent aggregation: 8.6% vs 16.8% (significant).
• sICH 7.9% vs 3.6% (NS).
• 90-day mRS 0-2: 59.6% vs 70.8% (NS).
• Intra-stent aggregation: 8.6% vs 16.8% (significant).
• sICH 7.9% vs 3.6% (NS).
• 90-day mRS 0-2: 59.6% vs 70.8% (NS).
Intervention
Tirofiban 500 ug IA bolus + 200 ug/h IV infusion for 20 h vs ASA 500 mg IV (equivalent to 300 mg PO)
Inclusion Criteria
Spain, multi-center. Occlusion of ICA-terminal/M1/M2/A1/P1 (if fetal origin); >=70% carotid stenosis or occlusion presumed atherosclerotic; ASPECTS >=6; planned eCAS during EVT.
Study Design
Arms: Tirofiban vs ASA
Patients per Arm: Tirofiban n=119 vs ASA n=121 (total 240)
Outcome
• Primary 24h carotid reocclusion: 7.2% vs 16.8% (P=0.036), NNT=10.4.
• Intra-stent aggregation: 8.6% vs 16.8% (sig).
• sICH: 7.9% vs 3.6% (NS).
• 90-day mRS 0-2: 59.6% vs 70.8% (NS).
• Intra-stent aggregation: 8.6% vs 16.8% (sig).
• sICH: 7.9% vs 3.6% (NS).
• 90-day mRS 0-2: 59.6% vs 70.8% (NS).