ischemic postconditioning in acute stroke patients receiving endovascular thrombectomy

Conditions: Stroke Acute; Cytoprotection; Ischemic Conditioning

Summary: this clinical trial will evaluate whether on-site ischemic postconditioning (ipostc) improves outcomes in acute stroke patients receiving endovascular thrombectomy (evt) and explore its mechanisms. the investigators aim to answer: (1) is on-site ipostc effective compared to evt alone? (2) what molecular markers and cellular pathways does on-site ipostc influence? participants will be randomized to evt alone or evt+ipostc (4 cycles of 2-minute balloon occlusion/reperfusion). the investigators will assess infarct size, functional outcomes, biomarkers (e.g., multi-omics, elisa, and clinical laboratory parameters), and safety (e.g., mortality, procedure-related complications).

this clinical trial is a single-center, prospective, blind endpoint, randomized -controlled trial. randomization will be in a 1:1 ratio, intervention arm (evt + on-site ipostc) or control arm (evt alone) in up to a total of 60 patients (30 subjects in each arm). on-site ipostc will be initiated immediately upon successful recanalization (etici 2b-3) using low pressure balloon in situ of the location of thrombus, consisting of 4 cycles of 2-minute cycles of balloon inflation (occlusion) followed by 2 minutes of deflation (reperfusion).

Eligibility criteria:
inclusion criteria: * the patient is ≥ 18 years of age. * the patient must have symptoms consistent with ais (i.e. face drooping, arm weakness, speech difficulty, etc.) , with symptoms severity of baseline nihss ≥ 6 and beginning less than 24 hours prior to presentation at hospital. * pre-stroke mrs ≤ 2. * baseline aspects ≥ 6. * unilateral middle cerebral artery occlusion, and/or internal carotid artery occlusion. * the patient is eligible for evt. * successful recanalization achieved through evt (etici 2b-3). * the patient is willing to provide written informed consent to participate in this clinical trial. exclusion criteria: * the interventionalist deems the study device unable to reach the target site. * adverse events related to thrombectomy, such as contrast extravasation, vascular rupture/perforation, dissection, or embolization to a new territory, detected on post-thrombectomy angiography. * stent placement performed in the m1 segment of the middle cerebral artery or the terminal segment of the internal carotid artery during thrombectomy. * angioplasty of more than two cycles of balloon inflation/deflation. * the patient is experiencing cardiogenic shock, systolic blood pressure \[sbp\] \ 100 bpm and arterial oxygen saturation (pulse oximetry) \<92% without additional oxygen. * the patient has known history of congestive heart failure, hepatic failure, end-stage kidney disease or severe renal failure (clearance \< 30ml/min/1.73m²). * the patient is febrile (temperature \> 37.5 °c) or has experienced an infection with fever in the last 5 days. * the patient has a known hypersensitivity or contraindication to aspirin, heparin, clopidogrel, tirofiban, or sensitivity to contrast media, which cannot be adequately pre-medicated. * the patient has a known history of bleeding diathesis, coagulopathy, cryoglobulinemia, sickle cell anemia, or will refuse blood transfusions. * the patient has a pre-ais life expectancy of \<1 year due to underlying medical conditions or pre-existing co-morbidities. * the patient is currently enrolled in another investigational drug or device trial. * the patient is apprehensive about or unwilling to undergo the required mri imaging at follow-up, has a documented or suspected diagnosis of claustrophobia, or has gadolinium allergy. * the patient is a female who is known to be pregnant. * other conditions deemed unsuitable for inclusion by the investigator.