Endovascular Treatment for Acute Large Vessel Occlusion With Ultra-Large Ischemic Core

Prior treatment

• Current treatment with direct thrombin inhibitors or factor Xa inhibitors;
• Concomitant malignancy or other conditions with life expectancy under 6 months;
• Prior endovascular attempt for this stroke;;

Other illness

• Evidence of intracranial hemorrhage on CT/MRI, including intraparenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, or subdural/epidural hemorrhage.
• Patients with severe organ failure (cardiac, pulmonary, renal, or hepatic);

Lab values

• Known coagulopathy, with international normalized ratio (INR) \>1.7 or platelet count \<100×10⁹/L;

Other

• Cerebral midline shift or herniation, or other ventricular mass effect with midline shift as confirmed on CT/MRI.
• Bilateral anterior circulation or acute multi-vessel occlusion involving both anterior and posterior circulation, confirmed by CTA or MRA.
• Blood pressure \>185/110 mmHg and is refractory to medicine.
• Female who is known to be pregnant;
• Currently participation in another clinical study;
• Other circumstances that the investigator considers inappropriate for participation.

• ≥18 years.
• Symptoms onset or Time last known well ≤ 24 h from randomization.
• Acute ischemic stroke due to an occlusion of the intracranial internal carotid artery, M1 or proximal M2 segment of the middle cerebral artery confirmed by CTA or MRA.
• NCCT or diffusion-weighted imaging (DWI) demonstrating ASPECTS ≤ 2 or infarct core volume (defined as rCBF \<30% on CTP) ≥ 100 mL.
• Selection imaging performed ≤ 3 hours before randomization.
• Pre-stroke mRS 0 - 1.
• Informed consent form was signed.