A Randomized, Controlled Trial to Evaluate the Safety and Effectiveness of the Route 92 Medical Reperfusion System (SUMMIT MAX)

Prior treatment

• Any known previous cerebral hemorrhagic event
• Known to be participating in another study involving an investigational device or drug
• For all patients, severe sustained hypertension with SBP \>200 and/or DBP \>120; for patients treated with a lytic, sustained hypertension despite treatment with SBP \>185 and/or DBP \>110

Other illness

• In the Investigator's opinion, any known comorbidity (including COVID-19 positivity) that may complicate treatment or prevent improvement or follow-up
• Known serious, advanced, or terminal illness with anticipated life expectancy \< 12 months
• Known history of severe allergy to contrast medium
• Known to have suffered a stroke in the past 90 days
• Known connective tissue disorder affecting the arteries (e.g. Marfan syndrome, Ehlers-Danlos syndrome)
• Clinical symptoms suggestive of bilateral stroke or stroke in multiple territories.
• Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) evidence of recent/ fresh cerebral hemorrhage (the presence of microbleeds is allowed)
• Known active or recent history of cocaine or methamphetamine abuse (within last 6 months)
• Ongoing seizure due to stroke
• Evidence of active systemic infection
• Known cancer with metastases

Lab values

• Known hemorrhagic diathesis, coagulation factor deficiency, or oral anticoagulant therapy with INR \>3.0
• Known baseline platelet count \<50,000/µL
• Known baseline blood glucose of \<50 mg/dL or \>400 mg/dL
• Treatment with heparin within 48 hours with a partial thromboplastic time more than two times the laboratory normal or treatment with any LMWH within 48 hours
• Renal failure with serum creatinine \>3.0 or Glomerular Filtration Rate (GFR) \<30

Other

• Known pregnancy or breast feeding
• Any known pre-existing coagulation deficiency
• Baseline CT or MRI showing intracranial tumor (except small meningioma \<= 2cm) or significant mass effect with midline shift due to the tumor
• Presumed septic thrombus, or suspicion of bacterial endocarditis
• Inability to access the cerebral vasculature in the opinion of the neurointerventional team
• Unlikely to be available for a 90-day follow-up (e.g. no fixed home address)
• Evidence of arterial dissection in a vessel that must be traversed
• Evidence of high-grade stenosis or occlusion (i.e., tandem occlusion) in a vessel that must be traversed
• Known history or presence of aneurysm or arteriovenous malformation (AVM) in the territory of the target lesion
• Angiographic evidence of a dissection in the extracranial or intracranial cerebral arteries
• Arterial stenosis requiring balloon angioplasty or stenting at the time of the procedure
• Angiographic evidence of multiple cerebrovascular occlusions (e.g., bilateral anterior circulation, anterior/posterior circulation, tandem occlusions)
• Angiographic evidence of known or suspected underlying intracranial vasculopathy or atherosclerotic lesions responsible for the target occlusion
• Angiographic evidence or suspicion of aortic dissection
• Angiographic evidence of an aneurysm or arteriovenous malformation (AVM) in the territory of the target lesion

• The consent process has been completed and documented according to applicable country regulations and as approved by the IRB / Ethics Committee
• Age \>=18 years
• Patient presenting with clinical signs consistent with an acute ischemic stroke
• Baseline National Institutes of Health Stroke Scale (NIHSS) score \>= 6
• Pre-stroke modified Rankin Score (mRS) \<= 2
• Baseline ASPECTS \>= 6
• Endovascular treatment initiated (defined as time of groin puncture) within 8 hours from time last known well
• If indicated, thrombolytic therapy shall be initiated per clinical guidelines. If eligible for thrombolytic therapy, subjects should be treated as soon as possible and lytic use should not be delayed regardless of potential eligibility for mechanical neurothrombectomy.
• The patient is indicated for aspiration neurothrombectomy with the Route 92 Medical Reperfusion System as determined by the Investigator
• Angiographic confirmation of a large vessel occlusion of the M1 segment of the middle cerebral artery or distal internal carotid artery