• Age at least 18 years old;

• Signs and symptoms are consistent with a new acute stroke, with low possibility of stroke mimics (e.g., no sudden coma, prior seizure disorder, suspected hypoglycemia);

• No prior stroke in the last 3 months;

• Time from stroke onset (last seen well) to randomization is within 9 hours;

• (1) Baseline NIHSS score at 6 or more and Intracranial ICA or MCA-M1 or MCA-M2 dominant occlusion, with or without tandem cervical carotid stenosis or tandem cervical occlusion, confirmed by preoperative CTA (or MRA, DSA) and consistent with signs and symptoms; or (2) Baseline NIHSS score at 6 or more with a hyperdense MCA sign on non-contrast CT; or (3) Baseline NIHSS score at 12 or more;

• NIHSS score 0 or 1 in the section of level of consciousness;

• No significant pre-stroke disability (pre-stroke mRS 0--1);

• ASPECTS at least 6 on non-contrast CT;

• Patient is planned for transfer to a EVT-capable hospital for EVT;

⁃ Signed informed consent from the patient or the legally authorized representative (LAR).