Endovascular Treatment of Chronic Intracranial Artery Occlusion

Prior treatment

• Prior attempted endovascular recanalization therapy before randomization
• Current participation in other studies involving investigational drugs or devices
• Excessive tortuosity of cervical vessels on CTA/MRA that may preclude endovascular therapy

Other illness

• Evidence of hemorrhage on CT or MRI
• Severe pre-stroke disability (modified Rankin Scale score ≥2) or life expectancy \<12 months
• Major comorbidities that may interfere with outcome assessment and follow-up (e.g., severe heart failure, renal failure, etc.)
• Uncontrolled seizure at the time of stroke onset
• Severe, persistent hypertension that remains uncontrolled despite active management (systolic blood pressure \>220 mmHg or diastolic blood pressure \>120 mmHg)
• Known allergy to iodine, heparin, or anaesthetics, or other definite contraindications to endovascular procedures
• Other severe, progressive, or terminal diseases (as judged by the investigator), or life expectancy \<24 months

Lab values

• Baseline platelet count \<50,000/μL
• Known inherited or acquired bleeding diathesis, coagulation factor deficiency, or recent oral anticoagulant therapy with an international normalized ratio (INR) \>3

Other

• Large hemispheric infarction involving \>50% of the middle cerebral artery territory on CT or MRI
• Suspected septic emboli or suspected bacterial endocarditis
• Pregnant women
• Evidence of intracranial tumour on CT or MRI (except meningioma)

• Age ≥18 years
• Occlusion of the unilateral middle cerebral artery, basilar artery, intracranial internal carotid artery, or vertebral artery, as confirmed by computed tomography angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography (DSA)
• Modified Rankin Scale (mRS) score of 0-2
• Presence of symptoms related to the occluded vessel, as determined by the physician, with the most recent symptom onset occurring more than 4 weeks and within 6 months prior to enrolment
• The subject or their legally authorised representative has provided written informed consent for the study