Advancing Reperfusion Therapy for Ischemic Stroke: Perfusion-guided Endovascular Intervention for Medium Vessel Occlusion Therapy

Inclusion Criteria: * 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 Criteria: * 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.