Objective:To evaluate the safety and efficacy of intravenous tirofiban in stent-assisted embolization of acute ruptured intracranial aneurysms.Methods:A total of 286 patients with acute ruptured intracranial aneurysms who received stent-assisted embolization in Department of Neurosurgery, Linyi People's Hospital from January 2020 to September 2022 were enrolled. According to different preoperative antiplatelet regiments, they were divided into aspirin combined with double resistant group (preoperatively taking orally loading dose of aspirin and clopidogrel, n=167) and tirofiban group (intravenously injecting tirofiban, n=119). Propensity score matching (PSM) was used to adjust for potential differences in age, gender, Hunt-Hess grading, hypertension history, diabetes history, smoking history, aneurysm location, aneurysm neck, aneurysm body-neck ratio, and stent types; incidences of perioperative hemorrhagic and ischemic complications, and neurological recovery status at discharge (scores of modified Rankin scale [mRS]≤2 as good recovery) were compared between the two groups. Results:After 1:1 PSM, 96 patients were included in each group. No significant difference in incidence of hemorrhagic complications was noted between the double resistant group (2.1%) and tirofiban group (0.0%, P>0.05). No significant difference in incidence of ischemic complications was noted between the double resistant group (9.3%, including 8 with intraoperative thrombosis and 1 with postoperative infarction) and tirofiban group (7.2%, including 6 with intraoperative thrombosis and 1 with postoperative infarction, P>0.05). No significant difference in good recovery rate at discharge was noted between double resistant group (86.4%) and tirofiban group (90.6%, P>0.05). Conclusion:In stent-assisted embolization therapy for acute ruptured intracranial aneurysms, preoperative intravenous tirofiban enjoys the same safety and efficacy compared with preoperative oral loading dose of aspirin and clopidogrel.