Study of Rescue Endovascular Therapy Added to Best Medical Management for Adults With Mild Ischemic Stroke and Large Vascular Occlusion More Than 24 Hours After Stroke Onset

What this Trial Is About

Researchers are investigating whether adding endovascular therapy EVT to best medical management benefits patients with minor acute ischemic stroke who experience early neurological deterioration END due to large vascular occlusion LVO in the anterior circulation. The study focuses on patients presenting more than 24 hours after stroke onset, a late treatment window, where the effectiveness of EVT is not well known. The goal is to assess the safety and efficacy of EVT in this specific group of patients. The study randomly assigns approximately 272 patients aged 18 years and older with minor stroke and LVO to one of two groups. One group receives best medical management alone, which includes standard therapies like monitoring vital signs, managing blood pressure, glucose, lipids, and antithrombotic treatment as appropriate. The other group receives best medical management plus EVT, which may include mechanical or aspiration thrombectomy, intra-arterial thrombolysis, angioplasty, or stenting, chosen by local interventionalists. Treatment is given after randomization, which occurs more than 24 hours after stroke onset. Participants will have seven study visits, including at randomization, 24, 48, and 72 hours after, at 7 days or discharge, and at 30 and 90 days post-randomization. Data collected include demographics, symptoms, lab tests, neuroimaging, and neurological function scales. The main outcome measures are the proportion of patients achieving a good clinical outcome at 90 days, assessed by the modified Rankin Scale, along with safety outcomes like intracranial hemorrhage and mortality. A Data and Safety Monitoring Board oversees participant safety throughout the trial.

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