Rescue Endovascular Therapy for Progressive Acute Mild Ischemic Stroke With Large Vascular Occlusion

Más betegség

• Pre-stroke mRS score >1;
• Imaging confirms the progression of symptoms caused by intracranial hemorrhage, brain edema, or other clear causes;
• Intracranial hemorrhage within 6 months, including cerebral parenchymal hemorrhage, ventricular hemorrhage, and subarachnoid hemorrhage;
• Have had gastrointestinal or urinary system bleeding, acute myocardial infarction, traumatic brain injury, or undergone major surgical procedures within the past month;
• Known allergies to treatment related drugs such as iodine contrast agents, etc; Known severe allergy (more than a rash) to contrast media uncontrolled by medications;
• Refractory hypertension (defined as persistent systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg);
• The expected survival time is less than 1 year (such as complicated with malignant tumor, serious heart and lung diseases, etc.)
• Other circumstances that the investigator considers inappropriate for participation in the trial or that may pose significant risks to patients (such as inability to understand and/or follow the study procedures and/or follow up due to mental disorders, cognitive or emotional disorders)

Laborértékek

• Known hemorrhagic tendency (including but not limited to): Baseline platelet count <40×109/L; on anticoagulant therapy with warfarin and International Normalized Ratio (INR) > 2 (Patients with no history or suspected coagulopathy do not need to wait for laboratory results of INR or APTT prior to enrollment) Severe heart, liver, kidney function damage or other severe late stage diseases of the system;
• Females who are pregnant, or those of child-bearing potential with positive urine or serum beta Human Chorionic Gonadotropin (HCG) test;

Egyéb

• The target vessel may have factors that may prevent it from completing endovascular treatment, such as a diameter less than 1.5mm, a tortuous vascular pathway, difficulty in reaching the target position with instruments, or difficulty in recovery;
• Severe stenosis or occlusion of multiple blood vessels;
• Combined with untreated intracranial aneurysms, intracranial tumors (excluding small meningiomas), or intracranial vascular malformations;
• Uncontrolled blood sugar abnormalities (less than 2.8mmol/l or greater than 22.2mmol/l);
• Participation in other interventional randomized clinical trials that may confound outcome assessment of the trial

• General Inclusion Criteria：
• Age ≥ 18 years；
• Presenting with symptoms consistent with an AIS and the initial NIHSS score <6 points；
• Symptom progression within 7 days of first onset；
• Randomization can be finished > 24 hours of stroke onset (stroke onset time is defined as last known well time)；
• Symptom progression to randomization time ≤ 24 hours；
• NIHSS score before randomization ≥ 6 points；
• Informed consent signed.
  • Specific Neuroimaging Inclusion Criteria
• CTA or MRA proved occlusion of Internal Carotid Artery (ICA) terminal or M1 segment of Middle Cerebral Artery;
• The progression of symptoms is caused by the recurrence of cerebrovascular diseases in the same vascular region, or the pathogenesis is caused by reduced blood flow perfusion;
• NCCT ASPECTS before randomization ≥ 6
• CTP or MRP assessment shows low perfusion in the target vessel area, and meets the following criteria: core infarction volume is less than 50ml, mismatch rate is greater than or equal to 1.8, and mismatch volume is greater than 15ml.