Endovascular Therapy for Acute Basilar Artery Occlusion With Large Ischemic Core

Acute basilar artery occlusion is associated with high mortality and severe disability. Previous randomized trials have demonstrated the benefit of endovascular therapy in selected patients with basilar artery occlusion; however, patients with large ischemic core, commonly defined by low posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), remain underrepresented and the benefit-risk profile of endovascular therapy in this subgroup is uncertain. This prospective, multicenter, randomized, open-label, blinded-endpoint trial will evaluate the efficacy and safety of endovascular therapy plus best medical management compared with best medical management alone in patients with acute basilar artery occlusion within 24 hours from symptom onset or last known well and pc-ASPECTS \

Inclusion Criteria: \- Clinical symptoms or imaging findings suggestive of acute posterior circulation ischemic stroke. Basilar artery occlusion confirmed by CTA, MRA, or DSA. Posterior circulation ASPECTS \185 mmHg or diastolic blood pressure \>110 mmHg that cannot be controlled with antihypertensive therapy. Known hereditary or acquired bleeding diathesis, coagulation factor deficiency, or current oral anticoagulant use with INR \>1.7. Blood glucose \400 mg/dL, platelet count \