Anisodine Hydrobromide for Patients With Acute Ischemic Stroke Undergoing Endovascular Therapy (HEAL)

Prior treatment

• Known hypersensitivity to anisodine hydrobromide or a history of severe intolerance after prior exposure.
• Participation in another interventional clinical study within 30 days before enrollment, or current participation in another interventional clinical study.

Other illness

• Evidence of intracranial hemorrhagic disease on head CT, including hemorrhagic stroke, epidural hematoma, subdural hematoma, intraventricular hemorrhage, or subarachnoid hemorrhage.
• History of congenital or acquired bleeding disorders, coagulation factor deficiency, thrombocytopenic disorders, or other clinically significant hemorrhagic conditions.
• Known allergy to iodinated contrast agents.
• Presence of clinical conditions that may be worsened by anticholinergic drugs, including but not limited to angle-closure glaucoma, urinary retention or benign prostatic hyperplasia with dysuria, or paralytic ileus.
• Severe arrhythmia or hemodynamic instability, including but not limited to tachyarrhythmia requiring cardioversion, recurrent syncope due to arrhythmia, vasopressor-dependent hypotension, or persistent hypotension.
• Severe psychiatric disorder, dementia, or impaired consciousness that would preclude informed consent or protocol-required follow-up.
• Malignant tumor or other severe systemic disease with an expected survival of less than 90 days.
• Any other condition that, in the investigator's judgment, makes the participant unsuitable for the study.

Other

• Vascular anatomy expected to preclude successful endovascular treatment because of excessive tortuosity or other technical reasons.
• Pregnant or breastfeeding women, or women planning pregnancy during the study period or within 90 days after enrollment.

• Age 18 to 80 years.
• Imaging-confirmed anterior-circulation large-vessel occlusion involving the intracranial internal carotid artery, the middle cerebral artery M1 segment, or the proximal M2 segment or a dominant M2 branch. A dominant M2 branch was defined as an M2 branch supplying ≥50% of the middle cerebral artery territory.
• Eligible for and planned to undergo endovascular treatment (EVT) within 24 hours according to current clinical practice.
• National Institutes of Health Stroke Scale (NIHSS) score ≥6 at baseline.
• Alberta Stroke Program Early CT Score (ASPECTS) ≥6 on baseline noncontrast CT.
• Pre-stroke modified Rankin Scale (mRS) score of 0 to 1.
• Provision of written informed consent by the participant or the participant's legally authorized representative.