Anisodine Hydrobromide for Patients With Acute Ischemic Stroke Undergoing Endovascular Therapy (HEAL-2)

Eligible participants will be randomly assigned to receive anisodine hydrobromide or matching placebo in addition to standard care, with efficacy and safety assessed during follow-up.

Inclusion criteria

• Age 18-80 years
• Anterior-circulation large-vessel occlusion involving the intracranial ICA, M1, or proximal/dominant M2
• Eligible for endovascular treatment within 24 hours of last known well
• Baseline NIHSS score ≥6
• Baseline ASPECTS ≥6
• Pre-stroke mRS score 0-1
• Written informed consent provided by the participant or legally authorized representative

Exclusion criteria

• Intracranial hemorrhage on baseline imaging
• Significant bleeding disorder or coagulopathy
• Vascular anatomy unsuitable for EVT
• Pregnancy, breastfeeding, or planned pregnancy within 90 days
• Known hypersensitivity or severe intolerance to anisodine hydrobromide
• Contraindication to anticholinergic drugs
• Severe arrhythmia or hemodynamic instability
• Severe psychiatric disorder, dementia, or impaired consciousness precluding consent or follow-up
• Malignancy or other severe systemic disease with a life expectancy <90 days
• Participation in another clinical trial within 30 days before enrollment or concurrently
• Any condition that, in the investigator's opinion, makes the patient unsuitable for study participation