## Protocol Section
### Identification Module
**NCT ID:** NCT06429384

**Brief Title:** Y-3 Injection in the Treatment of Acute Ischemic Stroke Phase II Clinical Trial

**Official Title:** Y-3 Injection in the Treatment of Acute Ischemic Stroke Phase II Clinical Trial -- Multicenter, Randomized, Double-blind, Parallel, Placebo-controlled Phase II Clinical Trial

#### Organization Study ID Info
**ID:** Y-3-LC-02
#### Organization
**Class:** OTHER
**Full Name:** Beijing Tiantan Hospital
### Status Module
#### Completion Date
**Date:** 2023-12-24

**Type:** ACTUAL

#### Expanded Access Info
#### Last Update Post Date
**Date:** 2024-05-28

**Type:** ACTUAL

**Last Update Submit Date:** 2024-05-20

**Overall Status:** COMPLETED

#### Primary Completion Date
**Date:** 2023-11-18

**Type:** ACTUAL

#### Start Date
**Date:** 2023-06-04

**Type:** ACTUAL

**Status Verified Date:** 2024-05

#### Study First Post Date
**Date:** 2024-05-28
**Type:** ACTUAL
**Study First Submit Date:** 2024-04-03
**Study First Submit QC Date:** 2024-05-20
### Sponsor Collaborators Module

#### Collaborators

**Class:** UNKNOWN

**Name:** NeuroDawn Pharmaceutical Co., Ltd.

#### Lead Sponsor

**Class:** OTHER

**Name:** Beijing Tiantan Hospital

#### Responsible Party

**Investigator Affiliation:** Beijing Tiantan Hospital

**Investigator Full Name:** Yongjun Wang

**Investigator Title:** Chief Physician

**Type:** PRINCIPAL_INVESTIGATOR

### Oversight Module

**Is FDA Regulated Device:** False

**Is FDA Regulated Drug:** False

**Oversight Has DMC:** False

### Description Module

**Brief Summary:** The objective of this clinical trial was to explore the efficacy and safety of Y-3 injection at different doses in patients with acute ischemic stroke within 48 hours of onset.

A multicenter, randomized, double-blind, parallel, placebo-controlled trial design was designed to include 240 participants.

Subjects press 1:1:1: 1 ratio of patients were randomly divided into Y-3 low-dose group (20 mg/ time, qd), medium-dose group (40 mg/ time, qd), high-dose group (60mg/ time, qd) and placebo control group, with 60 cases in each group. Random stratification factors include:

Time of onset (≤24 hours, \&gt; 24 hours). The patients were treated for 10 consecutive days (10 times) and followed up to 90 days after the first dose.

The trial was divided into three phases: screening/baseline, treatment, and follow-up.

Screening/baseline period: Subjects enter the screening/baseline period for screening examination after signing the informed consent.

Treatment period: Eligible subjects were randomly assigned at a ratio of 1:1:1:1 to receive Y-3 injection low-dose group, medium-dose group, high-dose group and placebo control drug for 10 consecutive days (10 times), during which relevant examinations required by the protocol were conducted and safety was assessed.

Follow-up period: Participants who finished treatment were followed up until 90 days after the first dose.

Stroke-related scale scores were performed at 10, 30, and 90 days after first use of the investigational drug The scores of Montgomery Depression Rating Scale (MSAS) and Hamilton Anxiety Scale (HAMA) were performed on the 10th and 90th days after the use of experimental drugs. Adverse events were recorded during treatment and follow-up to further assess safety

**Detailed Description:** A multicenter, randomized, double-blind, parallel, placebo-controlled trial design was designed to include 240 participants, who were randomly assigned to Y-3 low-dose group (20 mg/ time, qd), medium-dose group (40 mg/ time, qd), high-dose group (60 mg/ time, qd) and placebo control group in a ratio of 1:1:1:1. Each group had 60 cases.

Random stratification factors included: onset time (≤24 hours, \> 24 hours).The patients were treated for 10 consecutive days (10 times) and followed up to 90 days after the first dose.

The trial was divided into three phases:screening/baseline, treatment, and follow-up.

Screening/baseline period: Subjects enter the screening/baseline period for screening examination after signing the informed consent.Treatment period: Eligible subjects were randomly assigned at a ratio of 1:1:1:1 to receive Y-3 injection low-dose group, medium-dose group, high-dose group and placebo control drug for 10 consecutive days (10 times), during which relevant examinations required by the protocol were conducted and safety was assessed.Follow-up period: Participants who finished treatment were followed up until 90 days after the first dose.Stroke-related scale scores were performed on the 10th, 30th and 90th days after the first use of the experimental drug, and Montgomery Depression Rating Scale (MADRS) and Hamilton Anxiety Scale (HAMA) scores were performed on the 10th and 90th days after the first use of the experimental drug. Adverse events were recorded during treatment and follow-up to further assess safety.

### Conditions Module

**Conditions:**

- Acute Ischemic Stroke

### Design Module

#### Design Info

**Allocation:** RANDOMIZED

**Intervention Model:** PARALLEL

**Intervention Model Description:** Y-3 low dose group (20 mg/ time, qd), medium dose group (40 mg/ time qd), high dose group (60mg/ time, qd) and placebo control group.

##### Masking Info

**Masking:** QUADRUPLE

**Masking Description:** In a double-blind design, the researchers, the researchers involved in the trial effect evaluation, the data managers, the statistical analysts, and the subjects and their relatives or guardians were blind to the treatment groups.

**Who Masked:**

- PARTICIPANT

- CARE_PROVIDER

- INVESTIGATOR

- OUTCOMES_ASSESSOR

**Primary Purpose:** TREATMENT

#### Enrollment Info

**Count:** 240

**Type:** ACTUAL

**Phases:**

- PHASE2

**Study Type:** INTERVENTIONAL

### Arms Interventions Module

#### Arm Group 1

**Description:** Y-3 injection 20mg diluted with about 250 ml normal saline, intravenous infusion, qd, continuous medication for 10 days.

**Intervention Names:**

- Drug: Y-3 Injection/Y-3 blank injection

**Label:** Y-3 low-dose group (20 mg/dose, qd)

**Type:** EXPERIMENTAL

#### Arm Group 2

**Description:** Y-3 injection 40mg diluted with about 250 ml normal saline, intravenous infusion, qd, continuous medication for 10 days.

**Intervention Names:**

- Drug: Y-3 Injection/Y-3 blank injection

**Label:** Y-3 medium dose group (40 mg/dose, qd)

**Type:** EXPERIMENTAL

#### Arm Group 3

**Description:** Y-3 injection 60mg diluted with about 250 ml normal saline, intravenous infusion, qd, continuous medication for 10 days.

**Intervention Names:**

- Drug: Y-3 Injection/Y-3 blank injection

**Label:** Y-3 high-dose group (60 mg/dose, qd)

**Type:** EXPERIMENTAL

#### Arm Group 4

**Description:** Y-3 blank injection 10ml was diluted with about 250 ml normal saline, intravenous infusion, qd, and continuous medication for 10 days.

**Intervention Names:**

- Drug: Y-3 Injection/Y-3 blank injection

**Label:** Blank control group

**Type:** PLACEBO_COMPARATOR

### Interventions

#### Intervention 1

**Arm Group Labels:**

- Blank control group

- Y-3 high-dose group (60 mg/dose, qd)

- Y-3 low-dose group (20 mg/dose, qd)

- Y-3 medium dose group (40 mg/dose, qd)

**Description:** The first dose should be completed as soon as possible after randomization; The time from the second dose to the first dose shall not be less than 12h, but not more than 24h+1h; The time interval of each subsequent administration is 24h±1h;

**Name:** Y-3 Injection/Y-3 blank injection

**Type:** DRUG

### Outcomes Module

#### Other Outcomes

**Description:** Montgomery Depression Rating Scale scores on day 10 and day 90 were \&lt, respectively; Proportion of patients with scores of 12, ≥12, and ≥22.There are 10 items in the scale, with a total score of 60 points. The higher the score, the higher the degree of depression. MADRS \< 12 indicates no depressive symptoms, 12≤MADRS \< 22 indicates mild depression, 22≤MADRS \< 30 indicates moderate depression, and MADRS≥30 indicates severe depression.

**Measure:** Montgomery Depression Rating Scale scores on day 10 and day 90 were &lt, respectively; Proportion of patients with scores of 12, ≥12, and ≥22;

**Time Frame:** On the 10th and 90th day of treatment

**Description:** Hamilton Anxiety Scale (HAMA) scores on day 10 and day 90 were \&lt, respectively; Proportion of patients with scores of 7, ≥7, and ≥14.The scale used a 5-level scoring method, and the criteria for each level were: 0-asymptomatic; 1- Light; 2- Medium; 3- heavy; 4- Extremely heavy. The total score of Hamilton anxiety Scale is a very important basis to reflect the severity of patients' anxiety, that is, the less severe the disease, the lower the total score; The more severe the condition, the higher the total score. A total score of less than 7 is considered to have no symptoms of anxiety; A score of 7-13 is considered to be likely to have anxiety; A score of 14 to 20 is considered to be definitely anxious; 21 to 28 points, is considered to have significant anxiety; A score greater than 29 is considered likely to be severe anxiety.

**Measure:** Hamilton Anxiety Scale scores on day 10 and day 90 were &lt, respectively; Proportion of patients with scores of 7, ≥7, and ≥14.

**Time Frame:** On the 10th and 90th day of treatment

**Description:** Incidence of adverse events (AE) in each group;

**Measure:** Incidence of adverse events (AE) in each group;

**Time Frame:** During the test

**Description:** The incidence of treatment-related adverse events (TEAEs) in each group;

**Measure:** The incidence of treatment-related adverse events (TEAEs) in each group;

**Time Frame:** During the test

**Description:** The occurrence of important adverse events in each group;

**Measure:** The occurrence of important adverse events in each group;

**Time Frame:** During the test

**Description:** The occurrence of serious adverse events (SAEs) in each group;

**Measure:** The occurrence of serious adverse events (SAEs) in each group;

**Time Frame:** During the test

**Description:** The occurrence of suspicious and unexpected serious adverse reactions (SUSAR) in each group;

**Measure:** The occurrence of suspicious and unexpected serious adverse reactions (SUSAR) in each group;

**Time Frame:** During the test

**Description:** Detect blood routine through a blood cell analyzer, including white blood cell count, neutrophil count, lymphocyte count, hemoglobin, and platelet count.Use a biochemical analyzer to detect blood biochemistry, including alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin, direct bilirubin, creatinine, urea/urea nitrogen, uric acid, and so on. Detect coagulation function through a coagulation analyzer, including prothrombin time (PT), partially activated prothrombin time (APTT), international standardized ratio (INR), fibrinogen (FIB).Detect urine routine through a urine analyzer.These indicators are measured during the baseline period and post administration visit period to observe the impact of the drug on this indicator, whether the drug will cause AE and SAE，the occurrence of AE and SAE, the type and severity of AE and SAE, and ultimately to determine the safety of the drug.

**Measure:** Laboratory examination indicators: blood routine, urine routine, blood biochemistry, Laboratory examination indicators: blood routine, urine routine, blood biochemistry, coagulation function

**Time Frame:** During the test

**Description:** Detecting parameters such as heart rate, electrocardiogram, and QT interval through an electrocardiogram monitor.Detecting blood pressure through a blood pressure monitor.Detecting body temperature through a thermometer.Detect respiratory rate by observing changes in chest contour count of the subject.These indicators are measured during the baseline period and post administration visit period to observe the impact of the drug on this indicator, whether the drug will cause AE and SAE，the occurrence of AE and SAE, the type and severity of AE and SAE, and ultimately to determine the safety of the drug.

**Measure:** Vital signs: heart rate, blood pressure, body temperature, respiration

**Time Frame:** During the test

**Description:** Detect systems such as lungs, gastrointestinal tract, urinary system, musculoskeletal, skin, lymph nodes, etc. through observation, auscultation, percussion, palpation, and other examination methods. These indicators are measured during the baseline period and post administration visit period to observe the impact of the drug on this indicator, whether the drug will cause AE and SAE，the occurrence of AE and SAE, the type and severity of AE and SAE, and ultimately to determine the safety of the drug.

**Measure:** Physical examination of the whole body: lungs, gastrointestinal tract, urinary system, musculoskeletal system, skin, lymph nodes, and other systems.

**Time Frame:** During the test

**Description:** Laboratory evaluation not specified in the protocol, including parameters such as hematology, biochemical tests, urine analysis, etc. These indicators are measured during the baseline period and post administration visit period to observe the impact of the drug on this indicator, whether the drug will cause AE and SAE，the occurrence of AE and SAE, the type and severity of AE and SAE, and ultimately to determine the safety of the drug.

**Measure:** Clinical laboratory examination

**Time Frame:** During the test

**Description:** Discontinuation due to adverse events【AE includes abnormal laboratory test results (haematological, clinical biochemical, or urinalysis) or other safety assessments (e.g. electrocardiograms, radiological scans, vital signs measurements), including deterioration relative to baseline and deemed clinically significant in the medical and scientific judgment of the investigator; Exacerbation of pre-existing diseases; A new condition detected or diagnosed after the initiation of the investigational drug.】

**Measure:** Discontinuation due to adverse events;

**Time Frame:** During the test

**Description:** Discontinuation due to any other non-adverse event(Any discontinuation other than an adverse event)

**Measure:** Discontinuation due to any other non-adverse event.

**Time Frame:** During the test

#### Primary Outcomes

**Description:** The proportion of subjects with mRS score ≤ 1 on the 90th day of treatment .

**Measure:** The proportion of subjects with mRS score ≤ 1 on the 90th day of treatment .

**Time Frame:** 90th day of treatment

#### Secondary Outcomes

**Description:** Grade analysis of mRS Score on the 90th day of treatment;

**Measure:** Grade analysis of mRS Score on the 90th day of treatment;

**Time Frame:** 90th day of treatment

**Description:** The proportion of subjects with mRS Score ≤2 on the 90th day of treatment;

**Measure:** The proportion of subjects with mRS Score ≤2 on the 90th day of treatment;

**Time Frame:** 90th day of treatment

**Description:** Changes in NIH Stroke Scale from baseline on day 10 of treatment;

**Measure:** Changes in NIH Stroke Scale from baseline on day 10 of treatment;

**Time Frame:** 10th day of treatment

**Description:** Proportion of NIH Stroke of 0-1 or ≥4 reduction from baseline on day 10 and day 30 of treatment.The content of NIHSS score included: consciousness level (consciousness level, consciousness level questioning, consciousness level command), gaze, visual field, facial paralysis, upper limb movement, lower limb movement, body aid movement, sensation, language, dysarthria, neglect. The score ranges from 0 to 42, with higher scores indicating more severe nerve damage.Score 0 to 1: normal or nearly normal Scores 1-4: mild stroke/minor stroke .5 to 15 points: moderate stroke .15-20 points: moderate to severe stroke Scores 21-42: severe stroke

**Measure:** Proportion of NIH Stroke of 0-1 or ≥4 reduction from baseline on day 10 and day 30 of treatment.

**Time Frame:** On the 10th and 30th day of treatment

### Eligibility Module

**Eligibility Criteria:** Inclusion Criteria:

-

Only those who meet all the following criteria can be included in the group:

1. Age ≥ 18 years old and\<81 years old, regardless of gender;
2. After the onset of this disease, the National Institutes of Research Stroke Scale score was 6 ≤ NIHSS ≤ 20 points, and the sum of the 5th upper limb and 6th lower limb scores was ≥ 2 points. If patients receiving thrombolysis treatment were screened and evaluated based on the NIHSS score after thrombolysis;
3. Within 48 hours (including 48 hours) of onset;
4. Diagnosed as ischemic stroke according to the "Key Diagnostic Points for Various Major Cerebrovascular Diseases in China 2019", with good recovery after the first or last onset (mRS score ≤ 1 point before this onset);
5. Obtain informed consent from the patient or their legal representative voluntarily signed and approved by the ethics committee.

Exclusion Criteria:

-

Those who meet one of the following criteria during filtering cannot be included in the group:

1. Intracranial hemorrhagic diseases seen on cranial imaging: hemorrhagic stroke, epidural hematoma, intracranial hematoma, ventricular hemorrhage, subarachnoid hemorrhage, etc; If it is only oozing blood, the researcher can determine whether it is suitable for enrollment;
2. Severe consciousness disorder: The item score of NIHSS's 1a consciousness level is greater than 1 point;
3. Transient ischemic attack (TIA);
4. After controlling the patient's blood pressure, the systolic blood pressure remains ≥ 220mmHg or the diastolic blood pressure remains ≥ 120mmHg;
5. Previously diagnosed patients with severe mental disorders and severe dementia;
6. Patients previously diagnosed with depression or anxiety disorder;
7. Patients undergoing antidepressant or anti anxiety treatment;
8. Diagnosed with severe active liver diseases, such as acute hepatitis, chronic active hepatitis, liver cirrhosis, etc; Or ALT or AST\>2.0 × ULN;
9. Diagnosed with severe active kidney disease or renal insufficiency; Or serum creatinine\>1.5 × ULN;
10. After the onset of the disease, drugs with brain cytoprotection in the instructions have been used, such as edaravone, concentrated solution of edaravone and dextranol for injection, nimodipine, ganglioside, CDPC, piracetam, oxiracetam, butylphenylpeptide, human urinary kallidinogenase (Urinary Kallidinogenase), cinepazide, rat nerve growth factor, cerebrolysin (cerebroprotein hydrolysate), calf serum deproteinized injection Calf blood deproteinized extract injection, etc;
11. After the onset of this disease, thrombectomy or interventional therapy has been applied or planned to be applied;
12. Previously diagnosed with concurrent malignant tumors and undergoing anti-tumor treatment;
13. Previously diagnosed with severe systemic diseases, with an estimated survival period of\<90 days;
14. The patient is in pregnancy, lactation, and there is a possibility of pregnancy in the patient/patient partner who plans to conceive during the trial period;
15. Previously known allergies to this product or any of its excipients (15-hydroxystearic acid polyethylene glycol ester, propylene glycol, sodium hydroxide);
16. A history of major surgeries within 4 weeks prior to enrollment and assessed by the researcher as affecting neurological function scores or affecting 90 day survival;
17. Have participated in other clinical studies or are currently participating in other clinical studies within the first 30 days of randomization;
18. The researcher believes that it is not suitable to participate in this clinical study.

**Maximum Age:** 80 Years

**Minimum Age:** 18 Years

**Sex:** ALL

**Standard Ages:**

- ADULT

- OLDER_ADULT

### Contacts Locations Module

#### Locations

**Location 1:**

**City:** Beijing

**Country:** China

**Facility:** Beijing Tiantan Hospital, Capital Medical University Beijing

**State:** Beijing

**Zip:** 100000

**Location 2:**

**City:** Liuzhou

**Country:** China

**Facility:** Liuzhou Workers Hospital

**State:** Guangxi

**Zip:** 545000

**Location 3:**

**City:** Cangzhou

**Country:** China

**Facility:** Cangzhou Central Hospital

**State:** Hebei

**Zip:** 061000

**Location 4:**

**City:** Hengshui

**Country:** China

**Facility:** Harrison International Peace Hospital

**State:** Hebei

**Zip:** 053000

**Location 5:**

**City:** Daqing

**Country:** China

**Facility:** Daqing Oilfield General Hospital

**State:** Heilongjiang

**Zip:** 163000

**Location 6:**

**City:** Daqing

**Country:** China

**Facility:** Daqing People's Hospital

**State:** Heilongjiang

**Zip:** 163000

**Location 7:**

**City:** Nanyang

**Country:** China

**Facility:** Nanyang Second People's Hospital

**State:** Henan

**Zip:** 473000

**Location 8:**

**City:** Nanyang

**Country:** China

**Facility:** Nanyang South Stone Hospital

**State:** Henan

**Zip:** 473000

**Location 9:**

**City:** Nanyang

**Country:** China

**Facility:** The First Affiliated Hospital of Nanyang Medical College

**State:** Henan

**Zip:** 473000

**Location 10:**

**City:** Changsha

**Country:** China

**Facility:** Hunan Provincial People's Hospital

**State:** Hunan

**Zip:** 410000

**Location 11:**

**City:** Baotou

**Country:** China

**Facility:** The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology

**State:** Inner Mongolia Autonomous Region

**Zip:** 014000

**Location 12:**

**City:** Baotou

**Country:** China

**Facility:** Inner Mongolia Baotou Steel Hospital

**State:** Inner Mongolia Autonomous Region

**Zip:** 014100

**Location 13:**

**City:** Hohhot

**Country:** China

**Facility:** Inner Mongolia International Mongolian Medicine Hospital

**State:** Inner Mongolia Autonomous Region

**Zip:** 010000

**Location 14:**

**City:** Huai'an

**Country:** China

**Facility:** Huai 'an First People's Hospital

**State:** Jiangsu

**Zip:** 223001

**Location 15:**

**City:** Lianyungang

**Country:** China

**Facility:** Lianyungang First People's Hospital

**State:** Jiangsu

**Zip:** 222000

**Location 16:**

**City:** Lianyungang

**Country:** China

**Facility:** Lianyungang Second People's Hospital

**State:** Jiangsu

**Zip:** 222000

**Location 17:**

**City:** Taizhou

**Country:** China

**Facility:** Taizhou Second People's Hospital

**State:** Jiangsu

**Zip:** 225300

**Location 18:**

**City:** Xuzhou

**Country:** China

**Facility:** Xuzhou Central Hospital (Old Hospital Area)

**State:** Jiangsu

**Zip:** 221000

**Location 19:**

**City:** Xuzhou

**Country:** China

**Facility:** Xuzhou Central Hospital（New compound）

**State:** Jiangsu

**Zip:** 221000

**Location 20:**

**City:** Xuzhou

**Country:** China

**Facility:** Xuzhou First People's Hospital

**State:** Jiangsu

**Zip:** 221000

**Location 21:**

**City:** Pingxiang

**Country:** China

**Facility:** Pingxiang People's Hospital

**State:** Jiangxi

**Zip:** 337000

**Location 22:**

**City:** Beipiao

**Country:** China

**Facility:** Beipiao Central Hospital

**State:** Liaoning

**Zip:** 122100

**Location 23:**

**City:** Jinzhou

**Country:** China

**Facility:** The First Affiliated Hospital of Jinzhou Medical University

**State:** Liaoning

**Zip:** 121000

**Location 24:**

**City:** Shenyang

**Country:** China

**Facility:** Chinese People's Liberation Army Northern Theater Command General Hospital

**State:** Liaoning

**Zip:** 110000

**Location 25:**

**City:** Shenyang

**Country:** China

**Facility:** Shenyang First People's Hospital

**State:** Liaoning

**Zip:** 110000

**Location 26:**

**City:** Jinan

**Country:** China

**Facility:** Shandong Third Hospital

**State:** Shandong

**Zip:** 250000

**Location 27:**

**City:** Liaocheng

**Country:** China

**Facility:** Liaocheng People's Hospital

**State:** Shandong

**Zip:** 252000

**Location 28:**

**City:** Linyi

**Country:** China

**Facility:** Tancheng County First People's Hospital

**State:** Shandong

**Zip:** 276100

**Location 29:**

**City:** Tengzhou

**Country:** China

**Facility:** Tengzhou Central People's Hospital

**State:** Shandong

**Zip:** 277500

**Location 30:**

**City:** Dongyang

**Country:** China

**Facility:** Dongyang City People's Hospital

**State:** Zhejiang

**Zip:** 322100

#### Overall Officials

**Official 1:**

**Affiliation:** IRB of Beijing Tiantan Hospital Capital Medical University Beijing

**Name:** Shuya Li

**Role:** STUDY_DIRECTOR

### IPD Sharing Statement Module

**IPD Sharing:** NO

### References Module

#### References

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**Citation:** Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, Brott T, Cohen G, Davis S, Donnan G, Grotta J, Howard G, Kaste M, Koga M, von Kummer R, Lansberg M, Lindley RI, Murray G, Olivot JM, Parsons M, Tilley B, Toni D, Toyoda K, Wahlgren N, Wardlaw J, Whiteley W, del Zoppo GJ, Baigent C, Sandercock P, Hacke W; Stroke Thrombolysis Trialists' Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014 Nov 29;384(9958):1929-35. doi: 10.1016/S0140-6736(14)60584-5. Epub 2014 Aug 5.

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**Citation:** Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 Dec;50(12):e344-e418. doi: 10.1161/STR.0000000000000211. Epub 2019 Oct 30. Erratum In: Stroke. 2019 Dec;50(12):e440-e441.

**PMID:** 31662037

**Citation:** Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL; American Heart Association Stroke Council. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018 Mar;49(3):e46-e110. doi: 10.1161/STR.0000000000000158. Epub 2018 Jan 24. Erratum In: Stroke. 2018 Mar;49(3):e138. Stroke. 2018 Apr 18;:

**PMID:** 29367334

**Citation:** van Horn N, Kniep H, Leischner H, McDonough R, Deb-Chatterji M, Broocks G, Thomalla G, Brekenfeld C, Fiehler J, Hanning U, Flottmann F. Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients. J Neurointerv Surg. 2021 Jan;13(1):14-18. doi: 10.1136/neurintsurg-2020-015889. Epub 2020 May 15.

**PMID:** 32414889

**Citation:** Lee SH, Kim BJ, Han MK, Park TH, Lee KB, Lee BC, Yu KH, Oh MS, Cha JK, Kim DH, Nah HW, Lee J, Lee SJ, Kim JG, Park JM, Kang K, Cho YJ, Hong KS, Park HK, Choi JC, Kim JT, Choi K, Kim DE, Ryu WS, Kim WJ, Shin DI, Yeo M, Sohn SI, Hong JH, Lee J, Lee JS, Khatri P, Bae HJ. Futile reperfusion and predicted therapeutic benefits after successful endovascular treatment according to initial stroke severity. BMC Neurol. 2019 Jan 15;19(1):11. doi: 10.1186/s12883-019-1237-2.

**PMID:** 30646858

**Citation:** Meyer L, Alexandrou M, Leischner H, Flottmann F, Deb-Chatterji M, Abdullayev N, Maus V, Politi M, Roth C, Kastrup A, Thomalla G, Mpotsaris A, Fiehler J, Papanagiotou P. Mechanical thrombectomy in nonagenarians with acute ischemic stroke. J Neurointerv Surg. 2019 Nov;11(11):1091-1094. doi: 10.1136/neurintsurg-2019-014785. Epub 2019 Apr 27.

**PMID:** 31030188

**Citation:** Chamorro A, Lo EH, Renu A, van Leyen K, Lyden PD. The future of neuroprotection in stroke. J Neurol Neurosurg Psychiatry. 2021 Feb;92(2):129-135. doi: 10.1136/jnnp-2020-324283. Epub 2020 Nov 4.

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**Citation:** Li J, Zhang L, Xu C, Shen YY, Lin YH, Zhang Y, Wu HY, Chang L, Zhang YD, Chen R, Zhang ZP, Luo CX, Li F, Zhu DY. A pain killer without analgesic tolerance designed by co-targeting PSD-95-nNOS interaction and alpha2-containning GABAARs. Theranostics. 2021 Apr 3;11(12):5970-5985. doi: 10.7150/thno.58364. eCollection 2021.

**PMID:** 33897893

**Citation:** Li J, Zhang L, Xu C, Lin YH, Zhang Y, Wu HY, Chang L, Zhang YD, Luo CX, Li F, Zhu DY. Prolonged Use of NMDAR Antagonist Develops Analgesic Tolerance in Neuropathic Pain via Nitric Oxide Reduction-Induced GABAergic Disinhibition. Neurotherapeutics. 2020 Jul;17(3):1016-1030. doi: 10.1007/s13311-020-00883-w.

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**Citation:** Kaur H, Prakash A, Medhi B. Drug therapy in stroke: from preclinical to clinical studies. Pharmacology. 2013;92(5-6):324-34. doi: 10.1159/000356320. Epub 2013 Dec 12.

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**Citation:** Fisher M; Stroke Therapy Academic Industry Roundtable. Recommendations for advancing development of acute stroke therapies: Stroke Therapy Academic Industry Roundtable 3. Stroke. 2003 Jun;34(6):1539-46. doi: 10.1161/01.STR.0000072983.64326.53. Epub 2003 May 15.

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## Derived Section

### Condition Browse Module - Ancestors

- ID: D000002561

- Term: Cerebrovascular Disorders

- ID: D000001927

- Term: Brain Diseases

- ID: D000002493

- Term: Central Nervous System Diseases

- ID: D000009422

- Term: Nervous System Diseases

- ID: D000014652

- Term: Vascular Diseases

- ID: D000002318

- Term: Cardiovascular Diseases

- ID: D000010335

- Term: Pathologic Processes

- ID: D000020520

- Term: Brain Infarction

- ID: D000002545

- Term: Brain Ischemia

- ID: D000007238

- Term: Infarction

- ID: D000009336

- Term: Necrosis

### Condition Browse Module - Browse Branches

- Abbrev: BC10

- Name: Nervous System Diseases

- Abbrev: BC14

- Name: Heart and Blood Diseases

- Abbrev: All

- Name: All Conditions

- Abbrev: BC23

- Name: Symptoms and General Pathology

- Abbrev: Rare

- Name: Rare Diseases

### Condition Browse Module - Browse Leaves

- ID: M22306

- Name: Stroke

- Relevance: HIGH

- As Found: Stroke

- ID: M2400

- Name: Ischemic Stroke

- Relevance: HIGH

- As Found: Ischemic Stroke

- ID: M10543

- Name: Ischemia

- Relevance: HIGH

- As Found: Ischemic

- ID: M10282

- Name: Infarction

- Relevance: LOW

- As Found: Unknown

- ID: M5793

- Name: Cerebral Infarction

- Relevance: HIGH

- As Found: Ischemic Stroke

- ID: M5810

- Name: Cerebrovascular Disorders

- Relevance: LOW

- As Found: Unknown

- ID: M5204

- Name: Brain Diseases

- Relevance: LOW

- As Found: Unknown

- ID: M5742

- Name: Central Nervous System Diseases

- Relevance: LOW

- As Found: Unknown

- ID: M17400

- Name: Vascular Diseases

- Relevance: LOW

- As Found: Unknown

- ID: M22305

- Name: Brain Infarction

- Relevance: LOW

- As Found: Unknown

- ID: M5794

- Name: Brain Ischemia

- Relevance: LOW

- As Found: Unknown

- ID: M12284

- Name: Necrosis

- Relevance: LOW

- As Found: Unknown

- ID: T170

- Name: Acute Graft Versus Host Disease

- Relevance: LOW

- As Found: Unknown

### Condition Browse Module - Meshes

- ID: D000020521

- Term: Stroke

- ID: D000083242

- Term: Ischemic Stroke

- ID: D000002544

- Term: Cerebral Infarction

- ID: D000007511

- Term: Ischemia

### Misc Info Module

- Version Holder: 2024-05-31
