Advancing Reperfusion Therapy for Ischemic Stroke: Perfusion-guided Endovascular Intervention for Medium Vessel Occlusion Therapy
Advancing Reperfusion Therapy for Ischemic Stroke (ARTS): Perfusion-guided Endovascular Intervention for Medium Vessel Occlusion Therapy (PIVOT)
Beijing Tiantan Hospital
568 participants
Feb 8, 2026
INTERVENTIONAL
Summary
The investigators initiated a multicenter, prospective, randomized, open label, blinded-endpoint (PROBE) controlled trial to evaluate the efficacy and safety of perfusion-guided endovascular treatment (EVT) compared to standard medical care for patients with acute ischemic stroke due to medium vessel occlusion (MeVO) within 24 hours from symptom onset.
Eligibility
Inclusion Criteria7
- Age≥18 years old;
- Acute ischemic stroke symptom onset within 24 hours; including wake-up stroke and unwitnessed stroke, onset time refers to "last-seen normal time";
- Primary medium vessel occlusions confirmed by CTA/MRA, including non-dominant proximal M2 or mid-distal M2/M3 segments of the middle cerebral artery (MCA), A1/A2/A3 segments of the anterior cerebral artery (ACA), and P1/P2/P3 segments of the posterior cerebral artery (PCA) and responsible for the signs and symptoms of acute ischemic stroke;
- Pre-stroke modified Rankin scale (mRS) score ≤1;
- Baseline National Institutes of Health Stroke Scale (NIHSS) ≥8;
- Neuroimaging criteria: Target mismatch profile on CT perfusion or MRI+MR perfusion (ischemic core volume <70 mL, mismatch rate >1.2, mismatch volume >10 mL);
- Written informed consent from patients or their legally authorized representatives.
Exclusion Criteria13
- Any evidence of intracranial hemorrhage on qualifying imaging;
- Known (serious) sensitivity to radiographic contrast agents, nickel, titanium metals or their alloys and unable to complete CTP/PWI;
- Known history of arterial tortuosity, pre-existing stent, other arterial disease and/or known disease at the arterial access site that would prevent the device from reaching the target vessel and/or preclude safe recovery after EVT;
- Radiological confirmed evidence of mass effect or intracranial tumour (except small meningioma);
- Clinical diagnosis of cerebral vasculitis;
- Evidence of vessel recanalization prior to randomisation;
- Severe comorbidities, which will likely prevent improvement or follow-up;
- Any terminal illness such that the patient would not be expected to survive more than 1 year;
- Hypodensity in >1/3 MCA territory on non-contrast CT or significant hypodensity outside the current perfusion lesion suggesting distal clot migration (secondary MeVO);
- Multiple arterial occlusion;
- Pregnant women, nursing mothers, or reluctance to use effective contraceptive measures during the period of the trial;
- Unlikely to adhere to the trial protocol or follow-up;
- Participation in other interventional clinical trials within the previous 3 months.
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Interventions
EVT included thrombectomy with stent retrievers, thromboaspiration, intraarterial thrombolysis, balloon angioplasty, stenting, or a combination of these approaches at the discretion of the interventional team.
Administration of BMT should be done according to routine clinical practice and current international guidelines. Administration of BMT must not be delayed by randomisation and should be done independently from participation in this trial.
Locations(6)
View Full Details on ClinicalTrials.gov
For the most up-to-date information, visit the official listing.
NCT07323368