Safety and preliminary efficacy of intravenous tirofiban in acute ischemic stroke patient without arterial occlusion on neurovascular imaging studies.

•No treatment is available for stroke patients if they presented to ER >4.5h without visible arterial occlusion on image.•Tirofiban group has better short-term and long-term outcomes at 90days as compared to an age-gender-deficit matched cohort.•Intravenous Tirofiban for 24h is likely safe and potentially effective for selected patients with acute ischemic stroke.•The next step is to plan a phase 2 double-blinded randomized trial to formally assess the safety and efficacy of tirofiban.