To explore the safety of early administration of platelet aggregation inhibitors in acute ischemic stroke patients who received endovascular intervention due to intracranial atherosclerotic large artery occlusion in the anterior circulation. Methods: This retrospective study included 56 acute ischemic stroke patients who received recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis (IVT) bridging endovascular treatment for atherosclerotic large vessel occlusion in the anterior circulation. During the procedure, all patients were treated with tirofiban with an intravenous bolus (10 μg/kg), followed by continuous IV application [0.15 μg/(kg·min)] for up to 24 h post-procedure and bridged with 100 mg aspirin and 75 mg clopidogrel dual oral antiplatelet treatment if the follow-up CT found no obvious hemorrhage. Recanalization result was assessed by catheter angiography according to the modified Thrombolysis in Cerebral Ischemia (mTICI) scale. Intracerebral hemorrhage was assessed for each patient using the European Cooperative Acute Stroke Study (ECASS) Ⅱ criteria, and the incidence of intracerebral hemorrhage (ICH), symptomatic intracranial hemorrhage (sICH), and systemic bleedings was recorded. Patient death 3 days and 3 months after surgery were recorded; 3-month functional outcomes were assessed by the modified Rankin scale (mRS)． Results: Among the 56 patients with large artery occlusion in the anterior circulation due to intracranial atherosclerotic disease, 51 patients received successful intraoperative recanalization; 10 subjects showed ICH in 3 days, 4 of which were sICH, and no patient experienced systemic bleedings. Thrombocytopenia occurred in 2 patients, neither of which had ICH. Within 3 days after operation, 2 patients died, one from cerebral hernia and the other from severe pneumonia. All patients were followed up for 3 months during which 7 patients died and 29 patients achieved a ≤2 mRS score. Conclusion: The use of tirofiban in intravenous thrombolysis bridging endovascular therapy in acute ischemic stroke patients with anterior circulation atherosclerotic large artery occlusion is safe.