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Endovascular thrombectomy (EVT) is effective and safe for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) in major clinical trials. Whether the benefit of EVT in randomized trials could be generalized to clinical practice, especially in developing countries, remains unknown. The prospective Chinese ANGEL-ACT Registry (Endovascular Treatment Key Technique and Emergency Work Flow Improvement of Acute Ischemic Stroke) was established to evaluate the utilization, and subsequent outcomes of EVT treated AIS patients. This study is a multi-center, prospective registry study initiated by researchers, funded by National Key R&D Program of China. A total of 2,000 patients with acute ischemic stroke will undergo endovascular treatment. The hypothesis was that favorable outcomes from clinical trials could be achieved in clinical practice in China.
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| Measure | Description | Time Frame |
|---|---|---|
| Functional independence at 90 days (modified Rankin Scale of 0-2) | The range of modified Rankin Scale was from 0 to 6. 0-No symptoms;1-No significant disability;2-Slight disability;3-Moderate disability;4-Moderately severe disability;5-Severe disability;6 -Dead.A higher score indicates worse a outcome. | 90±7 days after enrollment |
| Symptomatic intracranial hemorrhage (sICH) within 12-36 hours after the procedure | Heidelberg Bleeding Classification): new intracranial hemorrhage detected by brain imaging associated with ≥4 points total National Institutes of Health Stroke Scale (NIHSS), ≥2 points in one NIHSS category, leading to intubation/ hemicraniectomy/ EVD placement or other major medical/surgical intervention, or absence of alternative explanation for deterioration | 12-36 hours after the procedure |
| Time from symptom onset to recanalization | The end of the procedure |
| Measure | Description | Time Frame |
|---|---|---|
| Recanalization rate at the end of the procedure | mTICI score 2b-3 | at the end of the procedure |
| Recanalization rate after the first attempt | mTICI score 2b-3 |
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Inclusion criteria
Exclusion criteria
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Patients with acute ischemic stroke caused by large vessel occlusion and receiving endovascular treatment.
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| Name | Affiliation | Role |
|---|---|---|
| Zhongrong Miao, PhD | Capital Medical University, Beijing Tiantan Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Beijing Tiantan Hospital | Beijing | Beijing Municipality | 100010 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40803585 | Derived | Bu Z, Sun D, Zhang X, Ma N, Gao F, Mo D, Meng Q, Miao Z; ANGEL-ACT study group. The role of intravenous tirofiban in patients undergoing endovascular treatment for acute intracranial atherosclerotic occlusion. J Stroke Cerebrovasc Dis. 2025 Oct;34(10):108420. doi: 10.1016/j.jstrokecerebrovasdis.2025.108420. Epub 2025 Aug 11. | |
| 40656129 |
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| ID | Term |
|---|---|
| D000083242 | Ischemic Stroke |
| ID | Term |
|---|---|
| D020521 | Stroke |
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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| At baseline, during the procedure, after the first attempt of endovascular treatment |
| Changes in NIHSS score immediately after the procedure | difference between NIHSS score immediately after the procedure and baseline | within 2 hours after the procedure |
| Changes in NIHSS score 24 hours after the procedure | difference between NIHSS score 24 hours after the procedure and baseline | 24 hours after the procedure |
| Changes in NIHSS score 7 days after the procedure or at discharge | difference between NIHSS score 7 days after the procedure or discharge and baseline | 7 days after the procedure or discharge |
| EQ-5D 90 days after the procedure | EQ-5D is a standardized instrument for measuring generic health status. Rated level can be coded as a number 1, 2, or 3, which indicates having no problems for 1, having some problems for 2, and having extreme problems for 3. As a result, a person's health status can be defined by a 5-digit number, ranging from 11111 (having no problems in all dimensions) to 33333 (having extreme problems in all dimensions).A higher score indicates a better outcome. | 90±7 days after the procedure |
| Barthel index (BI) 90 days after the procedure | The BI has a score of 0-100. A higher score indicates a better outcome. | 90±7 days after the procedure |
| Parenchymal hematoma (PH2) | PH2 is defined as hematoma in >30% of infarct area | 12-36 hours after the procedure |
| Any intracranial hemorrhage on imaging | 12-36 hours after the procedure |
| All-cause mortality within 90 days | 90±7 days after the procedure |
| Time from onset to arrival | At baseline, after arrival at the hospital |
| Time from arrival to imaging | At baseline, after taking any brain imaging |
| Time from imaging to puncture | At baseline, during the procedure, after successful groin puncture |
| Time from puncture to recanalization | At baseline, during the procedure, after successful recanalization |
| Tong X, Jia B, Ma G, Zhang X, Fiehler J, Flottmann F, Bechstein M, Broocks G, Hanning U, Kniep HC, Thomalla G, Deb-Chatterji M, Schon G, Zhang Y, Gao F, Ma N, Mo D, Miao Z, Meyer L; as the ANGEL-ACT & GSR-ET study group. Relationship Between Thrombolysis-to-Puncture Time and Outcomes of Endovascular Thrombectomy in Acute Ischemic Stroke. Neurol Clin Pract. 2025 Aug;15(4):e200434. doi: 10.1212/CPJ.0000000000200434. Epub 2025 Jul 11. |
| 38414555 | Derived | Bu Z, Sun D, Ma G, Jia B, Tong X, Huo X, Wang A, Ma N, Gao F, Mo D, Song L, Sun X, Deng Y, Li X, Wang B, Luo G, Su D, Miao Z. The impact of intraarterial, intravenous, and combined tirofiban on endovascular treatment for acute intracranial atherosclerotic occlusion. Front Neurol. 2024 Feb 13;15:1336098. doi: 10.3389/fneur.2024.1336098. eCollection 2024. |
| 37928150 | Derived | Li L, Lv J, Han JJ, Gao Y, Yan ZX, Wu Q, Zhang XL, Gao F. Nomogram model of functional outcome for endovascular treatment in patients with acute basilar artery occlusion. Front Neurol. 2023 Oct 19;14:1277189. doi: 10.3389/fneur.2023.1277189. eCollection 2023. |
| 37006506 | Derived | Deng Y, Yao Y, Tong X, Yin Y, Wang A, Zhang Y, Jia B, Huo X, Luo G, Ma N, Mo D, Song L, Sun X, Gao F, Chen D. Necessity and timing of angioplasty in acute large-vessel occlusion strokes due to intracranial atherosclerotic disease: A cohort analysis with data from the angel-ACT registry. Front Neurol. 2023 Mar 16;14:1087816. doi: 10.3389/fneur.2023.1087816. eCollection 2023. |
| 36725361 | Derived | Sun D, Huo X, Raynald, Jia B, Tong X, Wang A, Ma N, Gao F, Mo D, Miao Z; ANGEL-ACT study group. First pass effect of mechanical thrombectomy for acute vertebrobasilar artery occlusion: data from the ANGEL-ACT registry. J Neurointerv Surg. 2023 Dec;15(12):1201-1206. doi: 10.1136/jnis-2023-020065. Epub 2023 Feb 1. |
| 36689588 | Derived | Sun D, Raynald, Huo X, Jia B, Tong X, Ma G, Wang A, Ma N, Gao F, Mo D, Nguyen TN, Miao Z; ANGEL-ACT Study Group. Sex-Related Differences in Outcomes of Endovascular Treatment for Anterior Circulation Large Vessel Occlusion. Stroke. 2023 Feb;54(2):327-336. doi: 10.1161/STROKEAHA.122.041195. Epub 2023 Jan 23. |
| 36571164 | Derived | Li K, Sun D, Tong X, Wang A, Zhang Y, Ma G, Huo X, Ma N, Gao F, Mo D, Sun X, Peng G, Zhang X, Jia B, Miao Z. Incidence, predictors, and impact on outcome of underlying intracranial atherosclerotic disease in acute vertebrobasilar artery occlusion undergoing endovascular therapy: Data from ANGEL-ACT registry. Int J Stroke. 2023 Aug;18(7):856-863. doi: 10.1177/17474930221150111. Epub 2023 Jan 14. |
| 36274108 | Derived | Sun D, Huo X, Raynald, Wang A, Jia B, Tong X, Ma G, Mo D, Gao F, Ma N, Miao Z. Predictors of poor outcome after endovascular treatment for acute vertebrobasilar occlusion: data from ANGEL-ACT registry. Neuroradiology. 2023 Jan;65(1):177-184. doi: 10.1007/s00234-022-03065-x. Epub 2022 Oct 24. |
| 35354298 | Derived | Tong X, Burgin WS, Ren Z, Jia B, Zhang X, Huo X, Luo G, Wang A, Zhang Y, Ma N, Gao F, Song L, Sun X, Liu L, Deng Y, Li X, Wang B, Ma G, Wang Y, Wang Y, Miao Z, Mo D; ANGEL-ACT Study Group. Association of Stroke Subtype With Hemorrhagic Transformation Mediated by Thrombectomy Pass: Data From the ANGEL-ACT Registry. Stroke. 2022 Jun;53(6):1984-1992. doi: 10.1161/STROKEAHA.121.037411. Epub 2022 Mar 31. |
| 35243592 | Derived | Raynald, Sun D, Huo X, Jia B, Tong X, Ma G, Wang A, Mo D, Ma N, Gao F, Amin S, Ren Z, Miao Z; ANGEL-ACT study group. The Safety and Efficacy of Endovascular Treatment in Acute Ischemic Stroke Patients Caused by Large-Vessel Occlusion with Different Etiologies of Stroke: Data from ANGEL-ACT Registry. Neurotherapeutics. 2022 Mar;19(2):501-512. doi: 10.1007/s13311-022-01189-9. Epub 2022 Mar 3. |
| 35105182 | Derived | Ma G, Sun X, Cheng H, Burgin WS, Luo W, Jia W, Liu Y, He W, Geng X, Zhu L, Chen X, Shi H, Xu H, Zhang L, Wang A, Mo D, Ma N, Gao F, Song L, Huo X, Deng Y, Liu L, Luo G, Jia B, Tong X, Liu L, Ren Z, Miao Z; EPOCH Study and ANGEL-ACT Study Groups. Combined Approach to Eptifibatide and Thrombectomy in Acute Ischemic Stroke Because of Large Vessel Occlusion: A Matched-Control Analysis. Stroke. 2022 May;53(5):1580-1588. doi: 10.1161/STROKEAHA.121.036754. Epub 2022 Feb 2. |
| 35022299 | Derived | Sun D, Jia B, Tong X, Kan P, Huo X, Wang A, Raynald, Ma G, Ma N, Gao F, Mo D, Song L, Sun X, Liu L, Deng Y, Li X, Wang B, Luo G, Wang Y, Ren Z, Miao Z; ANGEL-ACT study group. Predictors of parenchymal hemorrhage after endovascular treatment in acute ischemic stroke: data from ANGEL-ACT Registry. J Neurointerv Surg. 2023 Jan;15(1):20-26. doi: 10.1136/neurintsurg-2021-018292. Epub 2022 Jan 12. |
| 34992575 | Derived | Ding Y, Gao F, Ji Y, Zhai T, Tong X, Jia B, Wu J, Wu J, Zhang Y, Wei C, Wang W, Zhou J, Niu J, Miao Z, Liu Y. Workflow Intervals and Outcomes of Endovascular Treatment for Acute Large-Vessel Occlusion During On-Vs. Off-hours in China: The ANGEL-ACT Registry. Front Neurol. 2021 Dec 21;12:771803. doi: 10.3389/fneur.2021.771803. eCollection 2021. |
| 34800279 | Derived | Huo X, Sun D, Raynald, Jia B, Tong X, Wang A, Ma N, Gao F, Mo D, Ma G, Amin S, Ren Z, Miao Z; ANGEL-ACT study group. Endovascular Treatment in Acute Ischemic Stroke with Large Vessel Occlusion According to Different Stroke Subtypes: Data from ANGEL-ACT Registry. Neurol Ther. 2022 Mar;11(1):151-165. doi: 10.1007/s40120-021-00301-z. Epub 2021 Nov 20. |
| 34593600 | Derived | Sun D, Tong X, Huo X, Jia B, Raynald, Wang A, Ma G, Ma N, Gao F, Mo D, Song L, Sun X, Liu L, Deng Y, Li X, Wang B, Luo G, Wang Y, Miao Z; ANGEL-ACT study group. Unexplained early neurological deterioration after endovascular treatment for acute large vessel occlusion: incidence, predictors, and clinical impact: Data from ANGEL-ACT registry. J Neurointerv Surg. 2022 Sep;14(9):875-880. doi: 10.1136/neurintsurg-2021-017956. Epub 2021 Sep 30. |
| 34587913 | Derived | Tong X, Li S, Liu W, Ren Z, Liu R, Jia B, Zhang X, Huo X, Luo G, Ma G, Wang A, Wang Y, Wang Y, Miao Z, Mo D; ANGEL-ACT study group. Endovascular treatment for acute ischemic stroke in patients with versus without atrial fibrillation: a matched-control study. BMC Neurol. 2021 Sep 29;21(1):377. doi: 10.1186/s12883-021-02386-3. |
| 33912244 | Derived | Tong X, Wang Y, Bauer CT, Jia B, Zhang X, Huo X, Luo G, Wang A, Ma N, Gao F, Mo D, Song L, Sun X, Liu L, Deng Y, Li X, Wang B, Ma G, Wang Y, Ren Z, Miao Z. Current status of aspiration thrombectomy for acute stroke patients in China: data from ANGEL-ACT Registry. Ther Adv Neurol Disord. 2021 Apr 12;14:17562864211007715. doi: 10.1177/17562864211007715. eCollection 2021. |
| 33657849 | Derived | Tong X, Wang Y, Fiehler J, Bauer CT, Jia B, Zhang X, Huo X, Luo G, Wang A, Pan Y, Ma N, Gao F, Mo D, Song L, Sun X, Liu L, Deng Y, Li X, Wang B, Ma G, Wang Y, Ren Z, Miao Z; ANGEL-ACT Study Group. Thrombectomy Versus Combined Thrombolysis and Thrombectomy in Patients With Acute Stroke: A Matched-Control Study. Stroke. 2021 May;52(5):1589-1600. doi: 10.1161/STROKEAHA.120.031599. Epub 2021 Mar 4. |
| 33596674 | Derived | Jia B, Ren Z, Mokin M, Burgin WS, Bauer CT, Fiehler J, Mo D, Ma N, Gao F, Huo X, Luo G, Wang A, Pan Y, Song L, Sun X, Zhang X, Gui L, Song C, Peng Y, Wu J, Zhao S, Zhao J, Zhou Z, Li Y, Jing P, Yang L, Liu Y, Zhao Q, Liu Y, Peng X, Gao Q, Guo Z, Chen W, Li W, Cheng X, Xu Y, Zhang Y, Zhang G, Lu Y, Lu X, Wang D, Wang Y, Li H, Ling L, Peng G, Zhang J, Zhang K, Li S, Qi Z, Xu H, Tong X, Ma G, Liu R, Guo X, Deng Y, Leng X, Leung TW, Liebeskind DS, Wang Y, Wang Y, Miao Z; ANGEL-ACT Study Groupdagger. Current Status of Endovascular Treatment for Acute Large Vessel Occlusion in China: A Real-World Nationwide Registry. Stroke. 2021 Apr;52(4):1203-1212. doi: 10.1161/STROKEAHA.120.031869. Epub 2021 Feb 18. |
| D009422 |
| Nervous System Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |