Methylprednisolone Sodium Succinate With Endovascular ThRombectomy for Large Ischemic STroke

Prior treatment

• Severe infectious disease unsuitable for corticosteroid therapy or concurrent contraindications to corticosteroid treatment;

Other illness

• Intracranial hemorrhage on NCCT or MRI;
• Allergy to corticosteroids;
• Allergy to contrast agents;
• History of gastrointestinal or urinary tract bleeding within the last month;
• Life expectancy \<6 months due to terminal illnesses such as malignancy or severe cardiopulmonary disease;
• Other conditions deemed unsuitable for study participation by the investigator, including inability to comprehend and/or comply with study procedures and/or follow-up due to psychiatric, cognitive, or emotional disorders.

Lab values

• Random blood glucose \>22.2 mmol/L (400 mg/dL);
• Known hereditary or acquired bleeding diathesis, coagulation factor deficiency, use of warfarin with an international normalized ratio (INR) \>1.7, or administration of novel oral anticoagulants within 48 hours of symptom onset;
• Platelet count \<90×10⁹/L;
• Renal dysfunction with an estimated glomerular filtration rate (eGFR) \<30 mL/min or serum creatinine \>220 μmol/L (2.5 mg/dL);

Other

• Current participation in another interventional clinical trial;
• Pregnancy or lactating;
• Persistent systolic blood pressure \>185 mmHg or diastolic blood pressure \>110 mmHg despite antihypertensive treatment;
• Intracranial aneurysm or arteriovenous malformation;
• Intracranial tumour with mass effect on imaging (except for small meningiomas);

• Aged 18 to 85 years;
• Clinically diagnosed acute ischemic stroke with screening NIHSS ≥6;
• Time from last known well to randomization ≤24 hours;
• Pre-stroke mRS score of 0-1;
• Occlusion of the responsible vessel confirmed by CT angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography (DSA) in intracranial segment of internal carotid artery (ICA), M1 or M2 segment of middle cerebral artery (MCA), and plan to undergo EVT;
• Alberta Stroke Program Early CT Score (ASPECTS) of 0-5 on NCCT, or ischemic core volume ≥70 mL (defined as regional cerebral blood flow \[rCBF\] \<30% on CT perfusion \[CTP\] or apparent diffusion coefficient \[ADC\] \<620×10-⁶ mm²/s on MRI);
• Informed consent obtained.