Methylprednisolone With Endovascular Thrombectomy for Large Ischemic Stroke

Other illness

• 1\. Intracranial hemorrhage confirmed by CT or MRI;
• 2\. Allergic to glucocorticoids or placebo components;
• 3\. Allergic to contrast agent;
• 4\. Presence of severe infectious disease unsuitable for glucocorticoid therapy or any other contraindication to glucocorticoid use;
• 8\. History of gastrointestinal or urinary tract bleeding within the last month;
• 12\. Uncontrolled hypertension with persistent systolic blood pressure \>185 mmHg or diastolic blood pressure \>110 mmHg, refractory to medical management;
• 13\. Life expectancy less than 6 months due to malignancy or severe cardiopulmonary disease;
• 14\. Other conditions deemed unsuitable for the study by the investigator, such as inability to comprehend or comply with study procedures or follow-up due to mental illness, cognitive or emotional disorder.

Lab values

• 5\. Known genetic or acquired coagulopathy, coagulation factor deficiency, use of warfarin with an international normalized ratio (INR) \>1.7, or use of novel oral anticoagulants within 48 hours of symptom onset;
• 6\. Platelet count \<90×10\^9/L;
• 7\. Random blood glucose \<2.8 mmol/L or \>22.2 mmol/L;
• 11\. Renal dysfunction (glomerular filtration rate \<30 ml/min or serum creatinine \>220 μmol/L \[2.5 mg/dl\]);

Other

• 9\. Current participation in another interventional clinical study;
• 10\. Pregnant or lactating women;

• 1\. Age ≥18 years;
• 2\. Clinically diagnosed with acute ischemic stroke and NIHSS ≥6;
• 3\. CT angiography (CTA), MR angiography (MRA) or digital subtraction angiography (DSA) confirmed occlusion of intracranial internal carotid artery (ICA) or M1/M2 segments of middle cerebral artery (MCA) and plan to undergo EVT;
• 4\. ASPECTS ≤5 (based on NCCT) or infarct core volume ≥70mL (defined as rCBF \<30% on CT perfusion or ADC \<620 on MRI);
• 5\. Time from symptom onset to randomization within 24 hours (from last known well);
• 6\. Pre-stroke mRS score 0-2;
• 7\. Written informed consent signed by patients or their family members.