Objective To study the clinical effect of tirofiban in the treatment of elderly patients with acute perforator artery cerebral infarction and its influence on nerve function and provide reference for clinic. Methods The clinical data of 80 elderly patients with acute perforator artery cerebral infarction admitted in Beijing Renhe Hospital from June 2019 to October 2022 were retrospective analyzed. Patients were divided into observation group (40 cases, received routine treatment combined with tirofiban intervention) and control group (40 cases, routine treatment only), according to the treatment methods. The treatment effect and adverse reaction rate of the two groups patients were compared. The serum inflammatory factors level of the two groups patients were recorded before and after treatment. Results The national institute of health stroke scale (NIHSS) score after 1 day, 1 week and the end of treatment of the two groups were significantly lower than those before treatment, and the NIHSS of observation group were lower than those of the control group (P<0.05). After treatment, the C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) of the two groups patients were significantly lower than those before treatment, and the serum inflammatory factors levels of observation group were lower than those of the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Tirofiban has a significant effect on the treatment of acute perforator artery cerebral infarction in the elderly, which is helpful to reduce inflammatory reaction, improve platelet function, protect nerve function, and drug security is good.