{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T15:44:13Z","timestamp":1782747853146,"version":"3.54.5"},"reference-count":22,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["No. 62272325"],"award-info":[{"award-number":["No. 62272325"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key R&D Program of China","doi-asserted-by":"crossref","award":["2023YFC2413500"],"award-info":[{"award-number":["2023YFC2413500"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Beijing Hospitals Authority\u2019s Ascent Plan","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"Beijing Natural Science Foundation","award":["No. 220016"],"award-info":[{"award-number":["No. 220016"]}]},{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2023ZD0505400"],"award-info":[{"award-number":["2023ZD0505400"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Stroke Vasc Neurol"],"accepted":{"date-parts":[[2025,9,14]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Contact aspiration (CA) and stent retriever (SR) thrombectomy are two equally recommended first-line endovascular techniques for treating acute ischaemic stroke due to large vessel occlusion. Whether CA is more effective in achieving complete reperfusion compared with SR in patients with acute basilar artery occlusion (ABAO) remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study aims to compare the efficacy and safety of CA versus SR as the first-line strategy during endovascular treatment in improving the rates of first-pass effect (FPE) for patients with ABAO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and design<\/jats:title>\n                    <jats:p>The ANGEL-COAST study is a prospective, multicentre, randomised controlled, open-label, blinded-endpoint (PROBE) clinical trial. Patients with acute ischaemic stroke due to ABAO within 24 hours from symptom onset will be recruited. Participants will be randomly assigned in a 1:1 ratio to either the CA or SR group. If the assigned treatment fails after three attempts, investigators may opt for alternative treatment strategies based on their clinical judgement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study outcomes<\/jats:title>\n                    <jats:p>The primary endpoint is the FPE rate, defined as eTICI (Extended Thrombolysis in Cerebral Infarction) 2C\/3 recanalisation after the first thrombectomy attempt without any rescue strategy. Key secondary endpoints include rates of modified FPE (eTICI \u22652b50), successful recanalisation (eTICI \u22652b50, eTICI \u22652b67, eTICI3) within \u22643 passes with the assigned device on conclusion of the procedure, procedural duration, use of rescue techniques and functional outcomes at 90 days, including modified Rankin Scale (mRS) 0\u20132 and mRS ordinal shift analysis. Safety outcomes include the rates of symptomatic intracerebral haemorrhage (sICH) at 36\u00b112 hours, all-cause 90-day mortality and procedure-related serious adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This is a head-to-head randomised trial to directly compare CA and SR in ABAO. The findings will help establish the optimal first-line endovascular treatment strategy for ABAO, potentially improving clinical outcomes in this high-risk group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05615038\">NCT05615038<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/svn-2025-004232","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T08:25:33Z","timestamp":1761639933000},"page":"381-388","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Contact aspiration versus stent retriever thrombectomy for acute basilar artery occlusion (ANGEL-COAST): rationale and design of a multicentre, prospective, randomised, open-label, blinded-endpoint trial"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct05615038","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05615038","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05320263","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8692-9838","authenticated-orcid":false,"given":"Sun","family":"Xuan","sequence":"first","affiliation":[{"name":"Interventional 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Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ligang","family":"Song","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"},{"name":"China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Gao","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"},{"name":"China National Clinical Research Center for 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Endovascular therapy of acute vertebrobasilar occlusions: influence of first-line strategy in the Endovascular Treatment in Ischemic Stroke (ETIS) Registry. 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