Please select the eligibility criteria that correspond to the clinical trial below.
Title: Acute Basilar Artery Occlusion: Endovascular Interventions vs Standard Medical Treatment
Brief Summary: This trial will provide valuable insights into the safety and efficacy of endovascular treatment for acute ischemic stroke patients with basilar artery occlusion within 8 hours of estimated occlusion time.


Options:
A: Inclusion Criteria:

1. Age ≥18 years;
2. Acute ischemic stroke consistent with infarction in the basilar artery territory;
3. Basilar artery occlusion confirmed by CTA/MRA/DSA, within 8 hours of estimated occlusion time;
4. Written informed consent from patient or surrogate, if unable to provide consent.

Exclusion Criteria:

1. Computed tomography (CT) or Magnetic Resonance Imaging (MRI) evidence of Cerebral hemorrhage on presentation;
2. Premorbid mRS ≥ 3 points;
3. Currently in pregnant or lactating;
4. Known serious sensitivity to radiographic contrast agents and nitinol metal;
5. Current participation in another investigation drug or device study;
6. Uncontrolled hypertension defined as systolic blood pressure \> 185 mmHg or diastolic blood pressure \> 110 mmHg that cannot be controlled except with continuous parenteral antihypertensive medication;
7. Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency; or oral anticoagulant therapy with INR \>1.7 or institutionally equivalent prothrombin time;
8. Baseline lab values: glucose \< 50 mg/dl or \> 400 mg/dl, platelets \<100\*109/L, or Hct\<25%;
9. Arterial tortuosity that would prevent the device from reaching the target vessel;
10. Life expectancy less than 1 year;
11. History of major hemorrhage in the past 6 months;
12. Angiographic evidence of significant cerebellar mass effect or acute hydrocephalus.
13. Angiographic evidence of bilateral extended brainstem ischemia.
B: Inclusion Criteria:

* New focal disabling neurologic deficit consistent with acute cerebral ischemia (NIHSS \>/= 6)
* Age \>/= 18 ≤ 85
* Clot retrieval procedure can be initiated within 8 hours from onset
* Large vessel proximal anterior circulation occlusion on MR or CT angiography (internal carotid, M1 or M2 MCA)
* Pretreatment MRI performed according to MR RESCUE protocol
* Signed informed consent obtained from the patient or patient's legally authorized representative
* Premorbid modified Rankin score of 0-2
* Allowed but not required: patients treated with IV tPA (tissue plasminogen activator) up to 4.5 hours from symptom onset with persistent target occlusion on post-treatment MR RESCUE MR or CT protocol performed at the completion of drug infusion (Note: Rapidly improving neurological signs prior to randomization is an exclusion)

Exclusion Criteria:

* NIHSS \>/= 30
* Contraindication to MRI (pacemaker etc)
* Acute intracranial hemorrhage
* Coma
* Rapidly improving neurological signs prior to randomization
* Pre-existing medical, neurological or psychiatric disease that would confound the neurological, functional, or imaging evaluations
* Pregnancy
* Known allergy to iodine previously refractory to pretreatment medications
* Current participation in another experimental treatment protocol
* Contrast-Enhanced Neck MRA (magnetic resonance angiography) or CTA (computed tomography angiography) suggests proximal ICA occlusion, proximal carotid stenosis \> 67%, or dissection
* INR \> 3.0 (international normalized ratio)
* PTT \> 3 x Normal (partial thromboplastin time)
* Imaging data cannot be processed by the MR RESCUE computer
* Renal Failure (serum creatinine \> 2.0 or Glomerular Filtration Rate \[GFR\] \< 30)

MRI Exclusion Criteria:

* Contraindication to MRI (pacemaker, etc)

CT Exclusion Criteria:

* Contraindication to iodinated contrast\*\*

  \*\*Examples of possible iodinated contrast contraindications include:
* Hyperthyroidism
* History of severe allergic reaction to iodinated contrast material
* History of sever kidney disease as an adult, including tumor or transplant surgery, or family history of kidney failure
* Paraproteinemia syndromes or multiple myeloma
* Collagen vascular disease
* Severe cardiac insufficiency
* Severely compromised liver function
* Current therapy with metformin, aminoglycosides
C: Inclusion Criteria:

1. age (18-80 years)
2. acute ischemic stroke
3. within 8 hours after symptom onset
4. a large-vessel confirmed by CTA/MRA (eg, internal carotid, middle cerebral M1 and/or M2 segments)
5. NIHSS(≥8 and ≤24)
6. patients or their legally authorised representatives provided signed, informed consent.

Exclusion Criteria:

1. CT or MRI evidence of intracranial haemorrhage/tumor
2. major ischaemic infarction (acute ischaemic change in more than a third of the middle cerebral artery territory)
3. NIHSS(≥25 and ≤7)
4. severe sustained hypertension (systolic blood pressure \>185 mm Hg or diastolic blood pressure \>110 mm Hg)
5. baseline glucose concentrations of less than 2·7 mmol/L or higher than 21.6 mmol/L
6. known haemorrhagic diathesis, coagulation factor deficiency, or oral anticoagulant therapy with an international normalised ratio of more than 1.7
7. treatment with heparin within 48 h with a partial thromboplastin time more than two times the laboratory normal, baseline platelet count of less than 100×10\^9/L
8. history of severe allergy (worse than rash) to contrast medium or nitinol
9. pregnancy
D: Inclusion Criteria:

1. Age 18 and older (i.e., candidates must have had their 18th birthday)
2. NIHSS ≥8 at the time of neuroimaging
3. Presenting or persistent symptoms within 6 hours of when groin puncture can be obtained
4. Neuroimaging demonstrates large vessel proximal occlusion (distal ICA through MCA bifurcation)
5. The operator feels that the stroke can be appropriately treated with traditional endovascular approaches (the ADAPT approach or conventional first-line stent retriever approach)
6. Pre-event Modified Rankin Scale score 0-1
7. Non-contrast CT/CTA for trial eligibility performed or repeated at treating ADAPT stroke center.
8. Consenting requirements met according to local IRB

Exclusion Criteria:

1. Patient is more than 6-hours from symptom onset
2. Rapidly improving neurologic examination
3. Absence of large vessel occlusion on non-invasive imaging
4. Presence of an existing or pre-existing large territory infarction
5. Known or suspected pre-existing (chronic) large vessel occlusion in the symptomatic territory
6. Absent femoral pulses
7. Excessive vascular access tortuosity that will likely result in unstable access platform.
8. Pregnancy; if a woman is of child-bearing potential a urine or serum beta HCG test is positive.
9. Severe contrast allergy or absolute contraindication to iodinated contrast.
10. Clinical history, past imaging or clinical judgment suggests that the intracranial occlusion is chronic.
11. Patient has a severe or fatal comorbidities that will likely prevent improvement or follow-up or that will render the procedure unlikely to benefit the patient.

Head CT or MRI Scan Exclusion Criteria

* Presence of blood on imaging (subarachnoid hemorrhage (SAH)), intracerebral hemorrhage (ICH), etc.)
* High density lesion consistent with hemorrhage of any degree
* Significant mass effect with midline shift
* Core infarct lesion volume \>50 cc.
* Large (more than 1/3 of the middle cerebral artery) regions of clear hypodensity on the baseline CT scan or ASPECTS of \< 7; Sulcal effacement and/or loss of grey-white differentiation alone are not contraindications for treatment.

Answer: A