To evaluate the efficacy and safety of endovascular therapy for posterior circulation ischemic stroke presenting more than 24 hours after symptom onset.
Age ≥ 18 years old
Baseline NIHSS score of 4 or higher, maintained prior to randomization
Stroke onset or more than 24 hours since the last known good state, but within 7 days
CTA/MRA/DSA confirmed occlusion of the responsible vessel in basilar artery or intracranial segments of both vertebral arteries (V4)
Hemorrhage on CT or MRI
Based on the judgment of the treating physician, the patient is considered unlikely to benefit from the trial (e.g., advanced dementia, severe pre-stroke disability (mRS ≥ 2), or high risk of early mortality)
Major comorbidities that may interfere with outcome assessment and follow-up (e.g., severe heart failure, renal failure, etc.).
Evidence of vascular recanalization prior to randomization