To evaluate the efficacy and safety of endovascular therapy for posterior circulation ischemic stroke presenting more than 24 hours after symptom onset.
Age ≥ 18 years old
Baseline NIHSS score of 4 or higher, maintained prior to randomization
Stroke onset or more than 24 hours since the last known good state, but within 7 days
CTA/MRA/DSA confirmed occlusion of the responsible vessel in basilar artery or intracranial segments of both vertebral arteries (V4)
Hemorrhage on CT or MRI
Based on the judgment of the treating physician, the patient is considered unlikely to benefit from the trial (e.g., advanced dementia, severe pre-stroke disability (mRS ≥ 2), or high risk of early mortality)
Major comorbidities that may interfere with outcome assessment and follow-up (e.g., severe heart failure, renal failure, etc.).
Evidence of vascular recanalization prior to randomization
Parallel
Endovascular treatment combined with standard pharmacological treatment
Procedure/SurgeryMechanical thrombectomy (stent retriever or aspiration) plus standard medical therapy (antiplatelet, statin, and risk factor control), specifically for posterior circulation stroke with onset \>24 h to ≤7 days.
Standard pharmacological treatment
DrugStandard medical therapy: antiplatelet, statin, and vascular risk factor control per stroke guidelines, without endovascular intervention.
Proportion of patients with an mRS score of 0-3 at 90 days
Symptomatic intracranial hemorrhage (sICH) (defined as a worsening of NIHSS by 4 or more points within 24 hours after random treatment, associated with intracranial hemorrhage)
Surgical-related complications
Stroke-related mortality at 90 days
EQ-5D-5L scale score at 90 days
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