Inhaled Nitric Oxide in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

This trial tests whether inhaled nitric oxide (iNO) — a gas that dilates blood vessels and is used in newborn respiratory care — can improve brain outcomes when administered during mechanical thrombectomy for acute ischemic stroke. During a major stroke, brain tissue is dying rapidly from lack of blood flow. Even after the blocked artery is reopened by thrombectomy, reperfusion injury (damage from blood suddenly rushing back) and residual microvascular spasm can limit recovery. Inhaled nitric oxide may help by improving blood flow to the small vessels of the brain and reducing this reperfusion damage. Eligible participants are adults aged 18–79 with a confirmed anterior circulation (MCA) stroke, NIH Stroke Scale ≥6, appropriate CT findings (ASPECT score ≥6, salvageable brain tissue on perfusion imaging), symptom onset within 16 hours, and a plan for general anesthesia during the procedure. Multiple exclusions apply: severe blood pressure extremes, pregnancy, severe bleeding disorders, recent tPA outside the window, coagulopathy, seizure at onset, extreme blood glucose, severe anemia, low kidney function, and others. Participants receive iNO during their procedure and are followed for functional neurological outcomes. This research is significant because even with thrombectomy — the best current stroke treatment — many patients have poor outcomes. An adjunctive therapy that protects brain tissue during and after reperfusion could translate into meaningful reductions in disability for one of the most devastating medical emergencies.