| Eligibility |
Inclusion Criteria:
1. Clinical signs and symptoms consistent with the diagnosis of an acute ischemic stroke
2. Subject can be treated within 24 hours after time last seen well (TLSW)
3. Subject belongs to one of the following subgroups:
1. Subject has received IV t-PA therapy; or
2. Subject is contraindicated for IV t-PA administration
4. Baseline NIHSS =6
5. No significant pre-stroke disability (pre-stroke mRS must be 0 or 1)
6. Age =18
7. Baseline ASPECTS =6
8. Subject willing/able to return for protocol required follow up visits
9. Subject or subject's Legally Authorized Representative (LAR) has signed the study
Informed Consent form,
10. If the procedure will start within 6 hours after the time last seen well, the
occlusion site is identified as the intracranial ICA, MCA (M1, M2, M3), ACA (A1, A2),
PCA (P1, P2), BA or VA as evidenced by MRA or CTA
11. If the procedure will start between 6 and 12 hours after the time last seen well, one
of the following (i) to (iii) is defined:
(i) ESCAPE criteria (if CTP-rCBF is not available or cannot be analyzed )
- the occlusion site is identified as the intracranial ICA, MCA (M1, M2, M3), ACA (A1,
A2), PCA (P1, P2), BA or VA as evidenced by MRA or CTA; and
- Moderate-to-good collateral circulation in MRA or CTA, (ii) Clinical Imaging
Mismatch (CIM):
- the occlusion site is identified as ICA or MCA (M1) as evidenced by MRA or CTA,
and defined as one of the following on MR-DWI or CTP-rCBF maps:
1. Age < 80; infarct core =30 ml if NIHSS =10;
2. Age < 80; infarct core 31 to 50 ml if NIHSS =20; or
3. Age = 80; infarct core =20 ml if NIHSS =10, (iii) Target Mismatch (TM):
- the occlusion site is identified as ICA or MCA (M1) as evidenced by MRA or CTA;
Age =90; NIHSS =6; and
- defined as following on MR-DWI or CTP-rCBF maps: infarct core volume <70 ml;
Penumbra volume >15 ml; and Penumbra volume/core volume >1.8,
12. If the procedure will start between 12 and 16 hours after the time last seen well, the
occlusion site is identified as ICA or MCA (M1) as evidenced by MRA or CTA, and (i)
Clinical Imaging Mismatch (CIM) or (ii) Target Mismatch (TM) is defined as one of the
following on MR-DWI or CTP-rCBF maps:
(i) Clinical Imaging Mismatch (CIM):
1. Age < 80; infarct core =30 ml if NIHSS =10;
2. Age < 80; infarct core 31 to 50 ml if NIHSS =20; or
3. Age = 80; infarct core =20 ml if NIHSS =10 (ii) Target Mismatch (TM): Age =90;
NIHSS =6; Infarct core volume <70 ml; Penumbra volume >15 ml; and Penumbra
volume/core volume >1.8
13. If the procedure will start between 16 and 24 hours after the time last seen well, the
occlusion site is identified as ICA or MCA (M1) as evidenced by MRA or CTA, and (i)
Clinical Imaging Mismatch (CIM) is defined as one of the following on MR-DWI or
CTP-rCBF maps:
1. Age < 80; infarct core =30 ml if NIHSS =10;
2. Age < 80; infarct core 31 to 50 ml if NIHSS =20; or
3. Age = 80; infarct core =20 ml if NIHSS =10
Exclusion Criteria:
- 1. Patients having allergy or contraindication to contrast agents or significant allergy
to metals 2. Patients who have been administered heparin within 48 hours and PTT/ APTT
exceeded double the normal values* 3. Patients with known hemorrhagic diathesis, OR blood
clotting factor deficiency OR patient who underwent oral anticoagulant therapy (warfarin
etc.), patient whose INR exceeds 3* 4. Patients with the platelet count under 30,000 mm3 5.
Patients with a blood sugar level under 50 mg/dL 6. Patients with hypertension (systolic
>185 mmHg, diastolic >110 mmHg) which cannot be controlled by drugs 7. Patients whose
estimated life expectancy is less than 6 months 8. Pregnant OR lactating female patients 9.
Patients participating in trials of medical products OR medical devices 10. Patients who
were judged as inappropriate to participate in this trial due to reasons other than those
mentioned above by the principal investigator (sub-investigator) for the study 11.
Pre-existing neurological or psychiatric disease that would confound the neurological or
functional evaluations, e.g. dementia with prescribed anti-cholinesterase inhibitor (e.g.
Aricept) 12. Seizures at stroke onset if it makes the diagnosis of stroke doubtful and
precludes obtaining an accurate baseline NIHSS assessment 13. Baseline hemoglobin counts of
<7 mmol/L (11.28 g/dL) 14. Abnormal baseline electrolyte parameters as defined by sodium
concentration <130 mmol/L, potassium concentration <3 mEq/L or >6 mEq/L 15. Renal failure
as defined by a serum creatinine >3.0 mg/dL (264 µmol/L) 16. Any active or recent
hemorrhage within the past 30 days 17. Presumed septic embolus, or suspicion of bacterial
endocarditis 18. Treatment with any cleared thrombectomy devices or other intra-arterial
(neurovascular) therapies prior to the procedure 19. Evidence of intracranial hemorrhage on
pre-treatment CT/MRI 20. CTA or MRA evidence of flow limiting carotid dissection,
high-grade stenosis, or complete cervical carotid occlusion requiring stenting at the time
of the index procedure (i.e., mechanical thrombectomy).
21. Excessive tortuosity of cervical vessels on CTA/MRA that would likely preclude device
delivery/deployment 22. Suspected cerebral vasculitis based on medical history and CTA/MRA
23. Suspected aortic dissection based on medical history and CTA/MRA 24. Intracranial stent
implanted in the same vascular territory that would preclude the safe deployment/removal of
the investigational device 25. Acute symptomatic arterial occlusions in more than one
vascular territory confirmed on CTA/MRA (e.g., bilateral MCA occlusions, or an MCA and
basilar artery occlusion).
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