Endovascular Therapy for Acute Basilar Artery Occlusion With Large Ischemic Core

Inclusion Criteria: \- Clinical symptoms or imaging findings suggestive of acute posterior circulation ischemic stroke. Basilar artery occlusion confirmed by CTA, MRA, or DSA. Posterior circulation ASPECTS \<7 on CT, CTA source images, or MRI-DWI. Age 18 to 80 years. Time from symptom onset or last known well to randomization within 24 hours. Written informed consent obtained from the patient or legally authorized representative. Baseline NIHSS score ≥6 before randomization. Exclusion Criteria: \- Pre-stroke modified Rankin Scale score ≥3. Pregnancy or lactation. Known allergy to contrast agents or nickel-titanium alloy. Current participation in another clinical trial. Systolic blood pressure \>185 mmHg or diastolic blood pressure \>110 mmHg that cannot be controlled with antihypertensive therapy. Known hereditary or acquired bleeding diathesis, coagulation factor deficiency, or current oral anticoagulant use with INR \>1.7. Blood glucose \<50 mg/dL or \>400 mg/dL, platelet count \<50 × 10\^9/L, or hematocrit \<25%. Life expectancy less than 1 year. Inability to complete 90-day follow-up. Definite history of cerebral vasculitis. Pre-existing neurological or psychiatric disorder that may interfere with neurological or functional assessment. Intracranial hemorrhage on CT or MRI, except for cerebral microbleeds \<5 mm on MRI. Vascular tortuosity, anatomical variation, or arterial dissection on CTA, MRA, or DSA that precludes endovascular treatment. Intracranial tumor,…