To explore the clinical characteristics of cerebral infarction caused by paramedian pontine arteries (PPA) branch atheromatous disease (BAD) - PPA-BAD. Methods: A retrospective analysis was conducted on 221 patients diagnosed with PPA-BAD in the Department of Neurology, Civil Aviation General Hospital from 2018 to 2024. According to the presence or absence of progressive motor deficits, patients were divided into a progressive group (140 cases) and a control group (81 cases); based on prognosis, they were classified into a good prognosis group (163 cases) and a poor prognosis group (58 cases); depending on whether they received recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy, they were divided into a treatment group (14 cases) and a control group (207 cases); for patients in the progressive group, based on whether tirofiban was used, they were divided into a tirofiban treatment group (42 cases) and a control group (98 cases). Demographic, clinical, and imaging data of each group were compared, and the effects of rt-PA intravenous thrombolysis and tirofiban treatment were explored. Results: (1) 140 cases (63.3% ) progressed after 6 hours of onset, indicating that PPA-BAD tends to easily progress and worsen; the proportion of patients with hyperlipidemia and those presenting with hemiplegia symptoms was higher in the progressive group, and the NIHSS scores at onset, peak, and discharge were higher (all P<0.05); the prognosis of the progressive group was worse than that of the control group (P<0.05). (2) Logistic multivariate analysis indicated that advanced age, history of old cerebral infarction, occurrence of progressive motor deficits, and large infarct size suggested a poor prognosis (all P<0.05); clinical manifestations accompanied by dizziness and ataxia tended to show a trend of good prognosis (P<0.05). (3) rt-PA intravenous thrombolysis and tirofiban were safe; there was no statistically significant difference in prognosis between the medication group and the control group (P>0.05). Conclusion: Patients with PPA-BAD are prone to developing progressive motor deficits; factors such as advanced age, history of old cerebral infarction, occurrence of progressive motor deficits, and large infarct size can lead to poor prognosis; currently, there is a lack of effective clinical predictive indicators, necessitating comprehensive individualized treatment; the application of rt-PA intravenous thrombolysis and tirofiban is recommended to improve therapeutic efficacy.