Emergency Stroke Unit for Acute Cerebrovascular Events ( ESU-ACE-B )

Mechanical thrombectomy is an effective reperfusion therapy for patients with acute ischemic stroke due to large vessel occlusion. Faster door-to-puncture time (DPT) is associated with significantly better clinical outcomes. With the development of low-field magnetic resonance imaging, it is poised to play an increasingly significant role in the early diagnosis and management of acute ischemic stroke. This prospective, multicenter, week-wise randomized controlled trial will compare the door-to-puncture time of patients with hyperacute ischemic stroke (between 4.5-6 hours after the onset of symptoms) managed in a standard stroke unit adherent to guidelines versus managed in Emergency Stroke Unit (a new stroke unit based on low-field magnetic resonance imaging).

Inclusion criteria

• Age ≥ 18 years;
• Can be treated between 4.5-6 hours of symptoms onset*(*Symptom onset is defined by the "last seen normal" principle);
• Presenting with ischemic stroke symptoms;
• Pre-stroke mRS score 0-1;
• Baseline NIHSS score ≥ 5;
• Eligible for endovascular thrombectomy;
• Informed consent signed.

Exclusion criteria

• Baseline NIHSS score < 5;
• Unable to undergo MRI because of claustrophobia;
• Patients with cardiac pacemaker/brain pacemaker/insulin pump implantation;
• Definite contraindication for endovascular thrombectomy;
• Patients with postictal hemiparesis (Todd's paralysis) or those with concomitant neurological/psychiatric conditions who are unable or unwilling to cooperate;
• Pregnant women, nursing mothers, or reluctance to use effective contraceptive measures during the period of trial;
• Participation in other interventional randomized clinical trials within 3 months before enrollment;
• Patients deemed unsuitable for participation in this trial by the investigator or those for whom participation in this trial may result in greater risks.