Safety and Efficacy of Adjunctive GM1 to Mechanical Thrombectomy for Acute Anterior Circulation Large Vessel Occlusion

Prior treatment

• 2.Baseline NIHSS is not obtained by a neurologist or emergency physician prior to sedation or intubation;
• 7.Systolic pressure \>185 mmHg or diastolic pressure \>110 mmHg, and cannot be controlled by antihypertensive drugs;

Other illness

• 3.Seizures at stroke onset which would preclude obtaining a baseline NIHSS;
• 5.Allergy to GM1 or excipients;
• 6.Severe contrast allergy or absolute contraindication to iodinated contrast;
• 15.Evidence indicates intracranial tumors (excluding small meningiomas), acute intracranial hemorrhage, tumors, or arteriovenous malformations (AVMs).
• 17\. The patient has neurological disease or mental disorder before onset, which affects the assessment of the condition;
• 19.Hereditary glycolipid metabolic disorders (ganglioside storage diseases, such as familial amaurotic idiocy, retinal degenerative diseases);
• 20.Autoimmune diseases, spine injuries, demyelinating diseases (e.g., Guillain-Barre syndrome)

Lab values

• 8.Blood glucose \<50 mg/dl (2.8 mmol/L) or \>400 mg/dl (22.2 mmol/L);
• 9.Platelet \<50\*10\^9/L;
• 10.Known genetic or acquired bleeding diathesis, deficiency of anticoagulant factors, or oral anticoagulant drugs and INR \> 1.7, or treated with direct oral anticoagulant agents in the prior 48 hours;
• 11.Known Severe renal Failure as defined by a serum creatinine \> 3.0 mg/dl (or 265.2 μmol/l) or glomerular filtration rate (GFR) \<30, or patient requires hemodialysis or peritoneal dialysis;

Other

• 1.Simultaneous acute occlusion of large vessels in both the anterior and posterior circulation or bilateral cerebral hemispheres.
• 4.Bilateral dilated pupils;
• 12.Patients that cannot complete 90-day follow-up (e.g. no fixed residence, overseas patients, etc.);
• 13.Presumed vasculitis or septic embolization;
• 14.Suspicion of aortic dissection;
• 16\. Significant mass effect causing midline shift.
• 18.Females who are pregnant or in lactation;
• 21.Participating in other clinical trials that could confound the evaluation of the study;
• 22.Other circumstances that the investigator considers inappropriate for participation or may pose a significant risk to patients.

• 1.Age ≥18 years and ≤80 years
• 2.Symptoms and signs consistent with anterior circulation ischemia;
• 3.Computed tomography angiography (CTA) /magnetic resonance angiography (MRA) /digital subtraction angiography (DSA) confirmed occlusion of intracranial segment of internal carotid artery (ICA) or M1/M2 segments of the middle cerebral artery (MCA M1/M2);
• 4.Acute ischemic stroke (AIS) selected for emergency endovascular treatment;
• 5.Premorbid mRS ≤1;
• 6.Time from symptom onset to randomization was within 24 hours, including patients with wake-up stroke or unwitnessed stroke; The time of symptom onset was defined as the Last Known Well (LKW);
• 7.National Institutes of Health Stroke Score (NIHSS) ≥6 at admission;
• 8.ASPECTS ≥3;
• 9.Informed consent obtained from the patient or his/her legal representative.