Endovascular Treatment Beyond 24 Hours for Acute Ischemic Stroke Caused by Anterior Circulation Large Vessel Stenosis

Launched by THE SECOND HOSPITAL OF ANHUI MEDICAL UNIVERSITY · Apr 26, 2025

Keywords

ClinConnect Summary

The EVT-BELATED trial is a clinical study looking at whether a specific procedure called endovascular therapy (EVT) can help patients who have had a stroke caused by a blocked blood vessel in the brain, even if they seek treatment more than 24 hours after their symptoms started. This trial is important because current guidelines suggest EVT is best performed within the first 24 hours, and researchers want to see if it can still be effective if treatment is given later.

To be eligible for this study, participants must be at least 18 years old and have experienced a stroke within 24 to 120 hours before joining the trial. They should also have a certain level of disability from the stroke and specific types of blood vessel blockages confirmed by imaging tests. Those who join the study will undergo EVT and will be monitored to see if it helps improve their condition. This trial is currently recruiting participants, and it aims to provide valuable insights into stroke treatment options for patients who may arrive at the hospital later than usual.

Gender

ALL

Eligibility criteria

• Inclusion criteria:
• • Age \> 18 years
• • Acute ischemic stroke with a time window of 24 to 120 hours from symptom onset or last known well, or progressive ischemic stroke with a time from symptom onset of 24 hours to 7 days (A ≥4-point increase in NIHSS attributable to the culprit vessel territory )
• • NIHSS score 5-25
• • Occlusion or ≥70% stenosis of the internal carotid artery or the M1/M2 segment of the middle cerebral artery, confirmed by CTA, MRA, or DSA, and deemed to be the culprit vessel responsible for the clinical presentation of acute ischemic stroke
• * Meet one of the following imaging criteria:
• • 1. MRI-based criteria: the infarct volume on DWI is less than one-third of the MCA territory, with evidence of DWI-FLAIR mismatch or MR perfusion showing a core infarct volume ≤30 ml, a mismatch ratio ≥1.8, and a mismatch volume ≥15 ml;
• • 2. CTA-based criteria: good collateral circulation on the affected side defined ascollateral filling \>50% of the MCA territory (Tan score ≥2) and an ASPECTS score ≥6);
• • 3. CTP-based criteria: ischemic core volume ≤30 ml, mismatch ratio ≥ 1.8, and mismatch volume ≥ 15mL
• • Signed informed consent obtained
• Exclusion criteria:
• • Pre-stroke mRS ≥ 2
• • Patients unable to undergo vascular imaging
• • Patients with known allergies to iodine contrast agents, anesthetics, or any contraindication to endovascular treatment
• • Prior endovascular therapy performed after the index stroke event during the current hospitalization
• • Intracranial hemorrhage identified on initial imaging
• • Platelet count \<50×10⁹/L, or presence of a known hemorrhagic diathesis , coagulation factor deficiencies, or use of oral anticoagulation therapy with an International Normalized Ratio (INR) \> 3.0
• • Refractory hypertension, defined as sustained systolic blood pressure \>200 mmHg or diastolic blood pressure \>120 mmHg despite optimal medical management
• • History of intracranial hemorrhage within the past 3 months, including parenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, epidural hemorrhage, or subdural hemorrhage
• • Significant mass effect with midline shift confirmed by CT or MRI
• • Suspected cardioembolic stroke or stroke due to non-atherosclerotic etiologies, such as:arterial dissection,Moyamoya disease, Infective endocarditis, or Immune-mediated vasculitis
• • Prior intracranial stent placement in the same culprit vessel
• • Major surgery performed within the past 30 days
• • Pregnant or current breastfeeding
• • Presence of severe systemic comorbidities with a life expectancy of less than 3 months
• • Deemed unsuitable for participation by the investigator for any reason