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Acute Ischemic StrokePhase 4ATILANCT05225961

ATILA Project: Aspirin Versus Tirofiban in Endovascular Treatment for Patients With Acute Ischemic Stroke Due to Tandem Lesion

A Phase 4 study testing Tirofiban and Acetylsalicylic acid in people with Acute Ischemic Stroke, run by Fundación Pública Andaluza para la gestión de la Investigación en Sevilla at 13 sites in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Patients with tandem lesions (TL) are defined as patients with an acute ischemic stroke (AIS) with occlusion of an intracranial vessel of the anterior circulation and an occlusion or severe stenosis (70-99%) of the origin of the ipsilateral internal carotid artery (ICA). Read more about this study

Who is it for?
Ages 18 to 100 years
Conditions the study is for
Acute Ischemic Stroke
What is being tested?
Tirofiban and Acetylsalicylic acid
Could I receive a placebo?
No, everyone receives an active treatment
How many people
240 participants
Where
13 sitesSpain
Study dates
20 Mar 2026to 20 Mar 2026
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 100 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients with acute ischemic stroke of the anterior territory secondary to a tandem lesion, with an indication for thrombectomy treatment according to the current recommendations of the Clinical Practice Guidelines, and the need for cervical stent placement.
  • The intracranial occlusion locations that may be included are: carotid "T", M1 and M2 segments of the middle cerebral artery, segment A1 of the anterior cerebral artery; and in the case that the posterior cerebral artery has fetal origin and is the site of intracranial occlusion.
  • ASPECTS (Alberta Stroke Program Early computerized Tomography Score) ≥6.
  • Greater than or equal to 18 years of age.
  • Signed informed consent.

Who cannot join

  • Patients under 18 years of age.
  • Patients with ASPECTS <6.
  • Bilateral strokes or those produced by simultaneous occlusion of an artery in the anterior and posterior territory.
  • Patients whose carotid stenosis is due to a re-stenosis or reocclusion of a pre-existing cervical stent.
  • Candidate patients for carotid puncture.
  • Previous treatment with double antiplatelet therapy for another cause prior to inclusion.
Show all 15Show fewer
  • Severe comorbidity and / or reduced life expectancy.
  • Modified Rankin scale (mRS)> 2.
  • Severe allergy to contrast medium.
  • Pregnant.
  • Patients with intracranial occlusive arteriosclerotic disease or extra or intracranial dissection.
  • Documented allergy to acetylsalicylic acid or Tirofiban.
  • Personal history of platelet penia (Platelets <100,000)
  • Concomitant anticoagulant treatment with presence of International Normalized Ratio (INR) > 1.7 in case of anti-vitamin K treatment or taking direct oral anticoagulant <48 hours ago)
  • Medical history of the patient that carries a high risk of bleeding according to the investigator's criteria.

Trial locations and contacts

13 sites in 1 country.

13 sites in 1 country

Spain13 sites
  • Complexo Hospitalario Universitario A Coruña

    A Coruña, A Coruña

  • General Hospital Dr. Balmis (Alicante)

    Alicante, Alicante

  • Complejo Hospitalario Torrecárdenas

    Almería, Almería

  • Complejo Hospital Universitario de Badajoz

    Badajoz, Badajoz

  • Germans Trias i Pujol Hospital

    Badalona, Barcelona

  • Hospital Universitario de Cruces

    Bilbao, Bilbao

  • Reina Sofía Hospital

    Córdoba, Córdoba

  • Josep Trueta Hospital

    Girona, Gerona

  • Ramón y Cajal Hospital

    Madrid, Madrid

  • Hospital Clínico Universitario Virgen de la Arrixaca, Murcia

    Murcia, Murcia

  • Virgen del Rocío Hospital

    Seville, Seville

  • Virgen Macarena Hospital

    Seville, Seville

  • Hospital Universitario y Politécnico de La Fe

    Valencia, Valencia

Other trials in Spain

About this study

Official title: Randomized Multi-center Clinical Trial to Assess Effectiveness and Safety of Tirofiban Versus Intravenous Aspirin in Patients With Acute Ischemic Stroke Secondary to Tandem Injury, Subject to Recanalization Therapy Through Endovascular Treatment

Patients with tandem lesions (TL) are defined as patients with an acute ischemic stroke (AIS) with occlusion of an intracranial vessel of the anterior circulation and an occlusion or severe stenosis (70-99%) of the origin of the ipsilateral internal carotid artery (ICA). The greatest current limitation in the management of this type of lesion is the use of antithrombotic medication (double antiaggregation) in the acute phase that is required in case of placing extracranial stent to stabilize the atheroma plaque. In relation to this antiplatelet regimen, the latest clinical practice guidelines warn about the risk of combining intravenous fibrinolysis with antiplatelet medication in the acute phase, since it seems to increase the risk of symptomatic intracranial hemorrhage (sICH). However, the non-stabilization of the carotid atheroma plaque is associated with higher rates of cervical reocclusion, poorer functional prognosis, and higher mortality.

Therefore, the use of a single antiplatelet agent could be a reasonable alternative. To establish the best protocol for mono-antiaggregant therapy in the acute phase of TL, the investigators propose to carry out a prospective multicenter randomized clinical trial.

  1. All patients with ischemic stroke secondary to TL in the anterior circulation candidates for mechanical thrombectomy in whom cervical endoprosthesis will be placed in the acute phase, will be included, randomized to two groups: 500 mg of intravenous (iv) Aspirin vs Low dose regimen of Tirofiban iv.
  2. Carotid reocclusion rates and sICH rates will be evaluated within the first 24 hours after mechanical thrombectomy . As a secondary objective, the functional prognosis at 3 months in both groups will be analyzed, as well as a panel of biomarkers predictors of reocclusion in both groups. Establishing an antiplatelet management protocol in the acute phase in these patients would be an innovative strategy not developed by any other group worldwide, and would place us at the forefront of research in the field. Likewise, developing a clinical-biological predictive model of carotid reocclusion will allow us to establish risk patients in which to plan alternative treatments. Reference hospitals in the treatment of ischemic stroke at the national level with sufficient experience in the management of this pathology will participate in the project.
Being tested
Tirofiban, Acetylsalicylic acid
Keywords
Ischemic Stroke, Tandem Lesion, Tirofiban, Stent, Mechanical thrombectomy
Medical subject headings
Ischemic Stroke

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • TirofibanDrug

    An intravenous bolus of 500 micrograms of Tirofiban will be intravenously administered in five minutes with an infusion pump (infusion rate: 120 milliliters / hour), which is equivalent to 500 micrograms of Tirofiban. After five minutes, a dose reduction will be programmed to 200 micrograms / hour (infusion rate: 4 milliliters / hour for 24 hours (maximum total infused dose of 96 milliliters). Tirofiban infusion started in the neuroradiology room should be maintained until a control brain computerized tomography (CT) scan is performed at 20 hours (+/-2 hours). Once the absence of parenchymal hematoma is demonstrated in control CT, loading doses of acetylsalicylic acid and clopidogrel will be intravenously administered in the Tirofiban group, and the perfusion must be maintained simultaneously of Tirofiban and oral double antiplatelet therapy for four hours, after which the administration of the experimental drug should be discontinued.

  • Acetylsalicylic acidDrug

    A single dose 500 milligrams of Acetylsalicylic acid (ASPIRINA®, 500 mg) will be intravenously administered. The solution for injection should be prepared on the spot and used immediately after preparation. It is highly recommended to administer as soon as possible after femoral puncture and always before stent placement, allowing a 10-minute delay after placement of the cervical endoprosthesis. In case of exceeding this time, the patient will be withdrawn from the trial. It will not be necessary to maintain aspirin infusion. In the Acetylsalicylic acid group, a head computerized tomography scan will also be performed at 20 (+/- 2 hours) after the endovascular procedure. Once the absence of parenchymal hematoma is demonstrated, a load of clopidogrel and 100 mg of Acetylsalicylic acid will be administered. Oral antiplatelet medication can be administered orally if the patient has a good level of consciousness and is not associated with dysphagia; or by placing a nasogastric tube.

Study groups in NCT05225961
Study groupRoleWhat they receive
TirofibanExperimentalAn intravenous bolus of 500 micrograms of Tirofiban will be intravenously administered in five minutes with an infusion pump (infusion rate: 120 milliliters / hour), which is equivalent to 10 ml (500 micrograms) of Tirofiban. After five minutes, a dose reduction will be programmed to 200 micrograms / hour (infusion rate: 4 milliliters / hour for 24 hours (maximum total infused dose of 96 milliliters).
Receives: Drug: Tirofiban
Acetylsalicylic acidActive comparatorA single dose 500 milligrams of Acetylsalicylic acid (ASPIRINA®, 500 mg) will be intravenously administered. One vial of ASPIRINA ® in not more than 250 ml in 0.9% sodium chloride solution, 5% and 10% glucose solution, Ringer's solution or lactated Ringer's. The solution for injection should be prepared on the spot and used immediately after preparation. It is highly recommended to administer as soon as possible after femoral puncture and always before stent placement, allowing a 10-minute delay after placement of the cervical endoprosthesis. In case of exceeding this time, the patient will be withdrawn from the trial.
Receives: Drug: Acetylsalicylic acid

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Carotid Reocclusion

    Outcome measure assessment will be performed using ultrasound doppler, in which carotid reocclusion is define by:

    • the presence at the level of the occlusion point, by a characteristic biphasic, brief and low speed pattern both in the Doppler spectrum and in color mode (color image with both orthodromic and antidromic flow, red-blue just proximal to the occlusion.
    • An anechoic appearance with a false appearance of permeable light, detecting the absence of flow in color and Doppler modes.

    Measured: Annually (single evaluation): within the first 24 hours (+/- 12hours)

  2. Platelet aggregation phenomena

    Outcome measure assessment will be performed using ultrasound doppler, in which carotid reocclusion is define by:

    • the presence at the level of the occlusion point, by a characteristic biphasic, brief and low speed pattern both in the Doppler spectrum and in color mode (color image with both orthodromic and antidromic flow, red-blue just proximal to the occlusion.
    • An anechoic appearance with a false appearance of permeable light, detecting the absence of flow in color and Doppler modes

    Measured: Annually (single evaluation): within the first 24 hours (+/- 12hours)

  3. Symptomatic intracranial hemorrhage (sICH)

    The sICH is defined as a new intracranial hemorrhage in brain computerized tomography within hospitalization related to an National institute of Health Stroke Scale score increase >4 points compared with stroke admission.

    Measured: Within first 24 hours after inclusion

Secondary outcomes (1)
  1. Good functional prognosis

    Defined as a score on the modified rankin scale (mRS) between 0-2 at 90 days.

    Measured: At 90 days (+/- 7 days) after inclusion

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Feb 2022
  2. Study start20 Mar 2026
  3. Primary completion20 Mar 2026
  4. Study completion20 Mar 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
240 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05225961
Sponsor's protocol ID
ATILA-ictus-2021
Acronym
ATILA
Status last verified
Mar 2026
First submitted
29 Nov 2021
Last updated
3 Apr 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Zapata-Arriaza E, Medina-Rodriguez M, Moniche Alvarez F, de Alboniga-Chindurza A, Aguilar-Perez M, Ainz-Gomez L, Baena-Palomino P, Zamora A, Pardo-Galiana B, Delgado-Acosta F, Valverde Moyano R, Jimenez-Gomez E, Bravo Rey I, Oteros Fernandez R, Escudero-Martinez I, Vielba-Gomez I, Morales Caba L, Diaz Perez J, Garcia Molina E, Mosteiro S, Castellanos Rodrigo MDM, Amaya Pascasio L, Hidalgo C, Freijo Guerrero MDM, Gonzalez Diaz E, Ramirez Moreno JM, Fernandez Prudencio L, Terceno Izaga M, Bashir Viturro S, Gamero-Garcia MA, Jimenez Jorge S, Rosso Fernandez C, Montaner J, Gonzalez Garcia A. Statistical analysis plan for the multicenter, open, randomized controlled clinical trial to assess the efficacy and safety of intravenous tirofiban vs aspirin in acute ischemic stroke due to tandem lesion, undergoing recanalization therapy by endovascular treatment (ATILA trial). Trials. 2024 Jan 9;25(1):35. doi: 10.1186/s13063-023-07817-9.

    PubMed 38195586

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Tirofiban and Acetylsalicylic acid in people with Acute Ischemic Stroke, run by Fundación Pública Andaluza para la gestión de la Investigación en Sevilla at 13 sites in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 15 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 3 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 13 sites in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Carotid Reocclusion (time frame: Annually (single evaluation): within the first 24 hours (+/- 12hours)). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05225961, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Apr 2026.

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