SUPERSTAR: Aspiration vs. Stent Retriever in Anterior Circulation LVO

This is a multicenter, open-label, blinded-endpoint, randomized controlled trial comparing super large bore catheter aspiration versus stent retriever thrombectomy as the first-line technique for anterior circulation large vessel occlusion in acute ischemic stroke. Eligible patients with acute ischemic stroke due to internal carotid artery intracranial segment and/or middle cerebral artery M1 occlusion will be randomized 1:1 to receive either aspiration using a super large bore catheter (inner diameter ≥0.080 inch) or stent retriever thrombectomy (allowing balloon guiding catheters or intermediate catheters with inner diameter \

Inclusion Criteria: 1. Age ≥ 18 years; 2. Clinically diagnosed with acute ischemic stroke, and pre-procedure imaging confirms that the culprit vessel is occlusion of the intracranial segment of the internal carotid artery and/or the middle cerebral artery M1 segment; 3. Pre-stroke modified Rankin Scale (mRS) score of 0-1; 4. Baseline National Institutes of Health Stroke Scale (NIHSS) score ≥ 6; 5. Alberta Stroke Program Early CT Score (ASPECTS) ≥ 3; 6. Time from symptom onset to initiation of endovascular treatment (arterial puncture) \< 24 hours; symptom onset time is defined as the "last known well" time; 7. Intravenous thrombolysis and/or mechanical thrombectomy are performed according to local guidelines, and intravenous thrombolysis does not delay mechanical thrombectomy; 8. Written informed consent is obtained from the patient or a family member. Exclusion Criteria: 1. Imaging shows acute or subacute intracranial hemorrhage (excluding microbleeds); 2. Imaging indicates an intracranial tumor (excluding meningiomas \