Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan RCT

Inclusion Criteria:

• Acute ischemic stroke patients who were treated with intravenous rt-PA therapy within 4.5 hours from onset and have persistent occlusion of IC and M1 proximal portion* confirmed by cerebral angiography.

  *: M1 proximal portion means the segment of MCA within 5mm from the internal carotid bifurcation.

• Patients who can receive endovascular treatment within 8 hours after the onset.
• Patients whose DWI-ASPECTS was 5 points and more, or CT-ASPECT was 6 points and more just before cerebral angiography.
• Patients whose NIHSS is between 8 and 29 points.
• Patients who are between 20 and 85 years.
• Gender does not matter.
• Consent of this study participants must be obtained from patients or legal representative in writing.

Exclusion Criteria:

• Patients whose neurological symptoms improved and NIHSS is eight points and less after intravenous rt-PA therapy.
• Patients whose mRS was 3 points and more before the onset. 3)Patients with past history of lumbar puncture or arterial puncture that were difficult of hemostasis.
• Patients with intracranial tumor
• Patients with hypersensitivity to contrast agent.
• Patients with serious renal disease.
• Patients with malignant tumor.
• Patients with pregnancy or suspect of pregnancy, or during lactation.
• Patients with findings of acute myocardial infarction or pericarditis after myocardial infarction.
• Patients who cannot be followed for 3 months.
• Patients with past history of cerebral aneurysm, cerebral arteriovenous malformation, cerebral venous thrombosis, or moyamoya disease.
• Patients with other occlusions besides ICA or M1 proximal portion.
• Patients with aortic dissection complicating endovascular treatment.
• Patients with tortuous arteries that prevent the navigation of the device to the target vessel.
• Patients considered inappropriate to participate in the study.