Strategy for Improving Stroke Treatment Response

Eligibility Criteria

• 1. Age 18 years and older
• 2. Suspected anterior circulation acute ischemic stroke
• 3. Presenting NIH Stroke Scale score \>/= 6
• 4. Favorable baseline neuroimaging
• 1. CT scan with ASPECTS of \>/=6, or MRI with ASPECTS of \>/=7 and
• 2. CT or MR Perfusion with a mismatch ratio \>1.2 between the volume of hypoperfusion and the volume of the ischemic core, an absolute difference in volume \> 10 ml, and an ischemic-core volume of less than 70 ml. and
• 3. Able to receive assigned study drug within 4.5 to 24 hours of stroke onset or last known well
• 5. Informed consent for the study participation obtained from participant or their legally authorized representatives.
• 1. Patients planned to receive endovascular treatment.
• 2. Patients that received or planned to receive intravenous thrombolysis.
• 3. Pre-stroke modified Rankin score \>2.
• 4. Known previous allergy to antibody therapy.
• 5. Known pregnancy or positive urine or serum pregnancy test for women of child bearing potential.
• 6. Known previous stroke in the past 90 days.
• 7. Known previous intracranial hemorrhage, neoplasm, subarachnoid hemorrhage, or arterial venous malformation.
• 8. Clinical presentation suggestive of a subarachnoid hemorrhage, even if initial CT scan was normal.
• 9. Surgery or biopsy of parenchymal organ in the past 30 days.
• 10. Known trauma with internal injuries or ulcerative wounds in the past 30 days.
• 11. Severe head trauma in the past 90 days.
• 12. Persistent systolic blood pressure \>180mmHg or diastolic blood pressure \>105mmHg despite best medical management.
• 13. Serious systemic hemorrhage in the past 30 days.
• 14. Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency, or oral anticoagulant therapy with INR \>1.7.
• 15. Platelets \<100,000/mm3.
• 16. Hematocrit \<25 %.
• 17. Elevated PTT above laboratory upper limit of normal.
• 18. Creatinine \> 4 mg/dl, or patients receiving renal dialysis, regardless of creatinine.
• 19. Received heparin or low molecular weight heparins (such as dalteparin, enoxaparin, tinzaparin) in full dose within the previous 24 hours.
• 20. Received Factor Xa inhibitors (such as fondaparinux, apixaban or rivaroxaban) within the past 48 hours.
• 21. Received direct thrombin inhibitors (e.g., argatroban, dabigatran, bivalirudin, desirudin, lepirudin) within 48 hours.
• 22. Received glycoprotein IIb/IIIa inhibitors within the past 14 days.
• 23. Known pre-existing neurological or psychiatric disease which would confound the neurological/functional evaluations.
• 24. Current participation in another research drug treatment protocol (i.e., participants could not start another experimental agent until after 90 days).
• 25. Concurrent acute myocardial infarction, pulmonary embolism, deep venous thrombosis or other thrombotic event that requires anticoagulation or anti-platelet treatment.