Precision Reperfusion Therapy for Disabling Minor Stroke With Large Vessel Occlusion Beyond Time Window

Prior treatment

• Major surgery within the last 1 month.
• Heparin or oral anticoagulant therapy within 48 hours.
• Thrombin or factor Xa inhibitors.
• Participation in any other investigational drug or device study within the last 3 months.

Other illness

• Significant pre-stroke neurological deficit (pre-stroke mRS ≥ 2).
• History of stroke within the last 3 months.
• History of intracranial hemorrhage.
• Suspected subarachnoid hemorrhage.
• Severe illness with life expectancy \< 3 months.

Lab values

• Platelet count \< 10⁵/mm³.
• Abnormal APTT.
• Blood glucose \< 50 mg/dL (2.7 mmol/L).

Other

• Intracranial tumor, vascular malformation, or aneurysm.
• Systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg.
• Pregnancy.
• Patients deemed unsuitable for the registry study by the investigator.

• Male or female subjects (age ≥ 18 years).
• Diagnosis of acute ischemic stroke, with intracranial hemorrhage ruled out by CT or MRI.
• Time from stroke onset or last known well to randomization is 4.5 to 24 hours.
• NIHSS score 2-5 and meeting the definition of disabling deficit: complete hemianopia (NIHSS question 3 score ≥ 2); severe aphasia (NIHSS question 9 score ≥ 2); neglect (NIHSS question 11 score ≥ 1); any persistent limb weakness against gravity (NIHSS question 6 or 7 score ≥ 2); any functional deficit considered potentially disabling by the physician and patient, such as inability to perform basic activities of daily living (bathing, independent walking, toileting, personal hygiene, and eating) or return to work.
• LVO (internal carotid artery, middle cerebral artery M1/M2 segments) confirmed by CTA or MRA, including tandem lesions.
• Core infarct volume \< 70 ml, ischemic penumbra volume ≥ 15 ml, and mismatch ratio ≥ 1.8, as shown by CTP or MRI+MRP.
• Written informed consent.