Endovascular Recanalization and Standard Medical Management for Symptomatic Nonacute Intracranial Artery Occlusion Trial

Exclusion Criteria

• •1. Intolerance or allergic reaction to a study medication without a suitable management alternative.
• •2. No atherosclerotic intracranial vasculopathies, such as dissection, moyamoya disease and vasculitis.
• •3. Concomitant intracranial aneurysms or any bleeding disorder.
• •4. Life expectancy \<1 year due to other medical conditions.
• •5. Large infarction core, defined as an ASPECTS \< 6 in anterior circulation and pc-ASPECTS \< 6 points in posterior circulation.
• •6. For patients with MCA M1 segment occlusion, concomitant ≥50% stenosis of the proximal internal carotid artery or other intracranial arteries.
• •7. For patients with intracranial segment occlusion of the vertebral artery, continuance of the occluded vertebral artery to the posterior inferior cerebellar artery with no stump.
• •8. Incomplete clinical and imaging data.
• •9. Coexistent cardioembolic source (e.g., atrial fibrillation, mitral stenosis, prosthetic valve, MI within six weeks, intracardiac clot, ventricular aneurysm and bacterial endocarditis).
• •10. Occlusive lesions with severe calcification.
• •11. Platelet count \<100,000/ml or history of heparin-induced thrombocytopenia.
• •12. Left ventricular ejection fraction \<30% or admission for heart failure in the prior 6 months.
• •13. Extreme morbid obesity that would compromise patient safety during the procedure or the periprocedural period.
• •14. Coronary artery disease with two or more proximal or major diseased coronary arteries with 70% stenosis that have not or cannot be revascularized.
• •15. Anticoagulation with Marcumar, warfarin or direct thrombin inhibitors or anti-XA drugs.
• •16. Chronic atrial fibrillation.
• •17. Any history of atrial fibrillation or paroxysmal atrial fibrillation in the past 6 months that is considered to require long-term anticoagulant therapy.
• •18. Other high-risk cardiogenic embolisms, including left ventricular aneurysm, severe cardiomyopathy, aortic or mitral mechanical heart valve, severe calcified aortic stenosis (valve area \< 1.0 cm2), endocarditis, moderate to severe mitral stenosis, left atrial thrombus or any intracardiac mass or known paradoxical embolism of unrepaired PFO.
• •19. Unstable angina defined as rest angina with ECG changes that is not amenable to revascularization (patients should undergo planned coronary revascularization at least 30 days before randomization).
• •20. Any major surgery, major trauma, revascularization procedure or acute coronary syndrome within the past 1 month.
• •21. serum creatinine \>2.5 mg/dl or estimated GFR \<30 cc/min.
• •22. Major surgery planned within 3 months after enrollment.
• •23. Currently listed or being evaluated for major organ transplantation (i.e., heart, lung, liver and kidney).
• •24. Participation in other trials and may affect the results of this study.
• •25. Inability to understand and cooperate with research procedures or provide informed consent.
• •26. Endarterectomy, bypass or stent implantation performed on the proximal end of the occlusion vessel.