Hemoadsorption for Severe Ischemic Stroke

Prior treatment

• Hemorrhagic transformation of PH2 type prior to randomization;
• Participation in another drug or device clinical trial within the past 30 days or ongoing enrollment in such trials;
• Absolute contraindications to hemoadsorption therapy.

Other illness

• Hemodynamic instability refractory to medical correction (systolic blood pressure \<70 mmHg or diastolic blood pressure \<50 mmHg) or decompensated heart failure (NYHA Class III or IV);
• Deep vein thrombosis (DVT) of the lower extremities before randomization;
• Life expectancy \<90 days due to malignancy;

Lab values

• Severe hepatic impairment (defined as ALT \>2 times the upper limit of normal or AST \>2 times the upper limit of normal) and renal impairment (defined as serum creatinine \>1.5 times the upper limit of normal or estimated glomerular filtration rate \[eGFR\] \<50 mL/min);
• Coagulopathy or thrombocytopenia (platelet count \<100×10⁹/L);

Other

• Brain herniation or decompressive craniectomy performed before randomization;
• Women of childbearing potential with a negative pregnancy test who refuse to use effective contraception, or pregnant/lactating women;

• 1.18 years ≤ age \< 80 years; 2.Pre-stroke mRS score ≤ 1; 3.Anterior circulation cerebral infarction within 48 hours of onset, meeting at least one of the following:
• 15≤ NIHSS score ≤32;
• 3\<GCS score ≤12;
• CT hypodensity area \>1/2 of the MCA territory; 4.hs-CRP ≥2 mg/L at randomization; 5.If reperfusion therapy is performed, no improvement in NIHSS score (still ≤32) post-treatment; 6.Signed informed consent obtained.