Clinical Research Directory

Inclusion Criteria: 1. ≥18 years. 2. Symptoms onset or Time last known well ≤ 24 h from randomization. 3. 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. 4. NCCT or diffusion-weighted imaging (DWI) demonstrating ASPECTS ≤ 2 or infarct core volume (defined as rCBF \<30% on CTP) ≥ 100 mL. 5. Selection imaging performed ≤ 3 hours before randomization. 6. Pre-stroke mRS 0 - 1. 7. Informed consent form was signed. Exclusion Criteria: 1. Evidence of intracranial hemorrhage on CT/MRI, including intraparenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, or subdural/epidural hemorrhage. 2. Cerebral midline shift or herniation, or other ventricular mass effect with midline shift as confirmed on CT/MRI. 3. Bilateral anterior circulation or acute multi-vessel occlusion involving both anterior and posterior circulation, confirmed by CTA or MRA. 4. Blood pressure \>185/110 mmHg and is refractory to medicine. 5. Known coagulopathy, with international normalized ratio (INR) \>1.7 or platelet count \<100×10⁹/L; 6. Current treatment with direct thrombin inhibitors or factor Xa inhibitors; 7. Patients with severe organ failure (cardiac, pulmonary, renal, or hepatic); 8. Concomitant malignancy or other conditions with life expectancy under 6 months; 9. Female who is known to be pregnant; 10. Prior endovascular attempt for this stroke;; 11. Currently participation in another clinical study; 12. Other circumstances that the investigator considers inappropriate for participation.