General inclusion criteria:
- Adults (≥ 18 and ≤ 85 years) with the final diagnosis of an acute ischemic stroke
- in-hospital stroke admissions with fluctuating clinical symptoms for patients who presented to EVT centers within 24 hours of LKW are not eligible
- NIHSS ≥ 6
- LKW > 24 to 72 hours
- Baseline ≤ 1
- Eligible for thrombectomy and medical management
- Signed informed consent obtained
- Subject willing to comply with the protocol follow-up requirements
- Anticipated life expectance of at least 3 months
Imaging inclusion criteria:
- Proven large vessel occlusion in ICA or MCA-M1 occlusion
- carotid occlusions can be cervical or intracranial, with or without tandem MRA lesions, as determined by MRA or CTA
- CT Aspects 3-10
- CT Perfusion ischemic core (rCBF <30%) volume ≤ 150 mL or MR Diffusion ischemic core (ADC <620×10-6 mm2/s) volume ≤ 150 mL
- if the perfusion software at the enrolling site uses another threshold/measure to define ischemic core, please use that measure to assess ischemic core criteria.
General exclusion criteria:
- Current participation in another investigational interventional drug or device study
- Baseline platelet count <100,000/μl
Imaging exclusion criteria:
- Evidence of intracranial tumor (except small meningioma < 3cm), acute intracranial hemorrhage, or arteriovenous malformation
- Significant mass effect, defined as midline shift (>3mm) using foramen of Monro as the marker for midline instead of septum pellucidum and/or effacement of sulci in contralateral hemisphere
- Evidence of internal carotid artery dissection that is flow limiting or aortic dissection
- Intracranial stent implanted in the same vascular territory that precludes the safe deployment/removal of the neurothrombectomy device
- Acute symptomatic arterial occlusions in more than one vascular territory confirmed on CTA/MRA
- Any signs of established infarct, demarcating hypodensity and area of cerebral edema on non-contrast CT
- CTA ASPECTS ≥2
- CT Perfusion ischemic core volume >150 mL or MR Diffusion ischemic core volume >150 mL
