Endovascular Recanalization StrategyBest Medical Management
Endovascular Recanalization Strategy: The endovascular approach is selected by the treating neurointerventionalist based on angiographic findings, occlusion characteristics, and procedural feasibility. Permitted techniques include mechanical thrombectomy using stent retriever and/or aspiration-based methods. Adjunctive endovascular procedures, such as balloon angioplasty, stent placement, or intra-arterial thrombolysis, may be used when deemed necessary to achieve or maintain vessel patency. Angiographic reperfusion is assessed during the procedure, and treatment is terminated once adequate revascularization is obtained. Subsequent medical management is individualized according to stroke mechanism, procedural findings, and post-treatment imaging.
Best Medical Management: Best medical management consists of comprehensive evidence-based medical therapy for acute ischemic stroke, encompassing acute supportive care, neurological and physiological monitoring, etiological evaluation, and secondary prevention strategies. Standard pharmacological treatments are administered as appropriate, together with risk factor modification and supportive care measures, in accordance with current guideline recommendations. Endovascular recanalization procedures are not included in this treatment strategy.
Study summary
This study assesses the efficacy and safety of endovascular therapy in patients with acute basilar artery occlusion with large core infarction within a multicenter, prospective, open-label, blinded endpoint, randomized controlled trial
Eligibility
Sex
ALL
Min age
18 Years
Max age
80 Years
Healthy volunteers
No
Inclusion Criteria:
1. The age ranged from 18 to 80 years
2. Acute ischemic stroke in posterior circulation, the time from stroke onset (or finally found normal) to randomization was within 24 hours
3. Acute basilar artery occlusion confirmed by CTA,MRA,or DSA
4. Posterior circulation large core infarction:NCCT or DWI showed pc-ASPECTS≤5, or Pons-Midbrain Index (PMI)≥3
5. NIHSS score ≥10 before randomization
6. Pre-stroke mRS of 0-2
7. Each patient or their legal representative must provide written informed consent before enrolment
Exclusion Criteria:
1. Any sign of intracranial hemorrhage (except microbleeds) on brain imaging prior to randomization
2. Complete cerebellar infarct with significant mass effect, or bilateral thalamic infarction as evidenced by baseline neuroimaging
3. Known or highly suspected chronic occlusion of basilar artery
4. History of contraindication for contrast medium (except mild rash)
5. Current pregnant or breast-feeding
6. Refractory hypertension (defined as systolic blood pressure\>220 mmHg or diastolic blood pressure\>110 mmHg) that cannot be controlled by drug treatment;
7. Known to have dementia or psychiatric disease unable to complete neurological assessment and follow-up
8. It is known that patients with dementia or mental illness cannot complete neurological function assessment and follow-up
9. Patients whose life expectancy is less than 1 year (such as patients with malignant tumor, advanced cardiopulmonary disease, etc.)
10. Enrolled in another drug or device trial or expected to participate in another drug or device treatment trial within the following 3 months
11. Any other condition (in the opinion of the site investigator) that inappropriate to participate this study
12. CTA/MRA/DSA confirmed occlusion of anterior and posterior circulation
13. Central nervous system vasculitis has been diagnosed or clinically suspected
14. Known hereditary or acquired bleeding tendency, lack of coagulation factors, or oral anticoagulants with INR\>1.7
15. Blood glucose\<2.7 or\>22.2 mmol/L; Platelet count\<50×109/L, glomerular filtration rate\<30ml/min or serum creatinine ≥ 3 mg/dl
16. Acute cerebral infarction occurred within 48 hours after cardio cerebral vascular intervention or major surgery (patients over 48 hours can be included in the group)
Primary outcome measure(s)
Rate of modified Rankin scale 0-3 at 90 (±14) days after randomization — 90±14 days after randomization The modified Rankin scale (mRS) ranged from 0 to 6, with a score of 0 indicating no disability, 1 no clinically significant disability, 2 slight disability, 3 moderate disability but remaining able to walk unassisted, 4 moderately severe disability,5 severe disability, and 6 death.
Trial sites (1)
Facility
City
Region
Status
Beijing Tiantan Hospital, Capital Medical University
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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