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

Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan Randomized Controlled Trial

The aim of this study is to clarify the efficacy of the endovascular treatment for acute ischemic stroke patients with large vessel occlusion and are not respond to intravenous recombinant tissue plasminogen activator (rt-PA) therapy.

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.