Advancing Reperfusion Therapy for Ischemic Stroke: Safety and Efficacy of Anakinra for Futile Reperfusion Following Endovascular Treatment in Patients With Acute Ischemic Stroke

Inclusion Criteria: * Age between 18-80 years old (both inclusive); * Acute ischemic stroke symptom onset within 24 hours; including wake-up stroke and unwitnessed stroke, onset time refers to "last-seen normal time"; * Pre-stroke modified Rankin scale (mRS) score ≤1; * Baseline National Institutes of Health Stroke Scale (NIHSS) 6-25 (both inclusive); * Internal carotid artery (ICA) or middle cerebral artery (MCA) M1/M2 occlusions confirmed by CTA/MRA and responsible for the signs and symptoms of acute ischemic stroke; * Successful recanalization (eTICI 2b50-3) after endovascular treatment; * Written informed consent from patients or their legally authorized representatives. Exclusion Criteria: * Allergy to Anakinra; * NIHSS consciousness score 1a \>2, or epileptic seizure, hemiplegia after seizures (Todd's palsy) or other neurological/mental illness such that the patient is not able to cooperate or unwilling to cooperate; * Unable to perform CTP or PWI; * Acute or past intracerebral hemorrhage (ICH) (including parenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, subdural/epidural hematoma) confirmed by CT or MRI; * Multiple arterial occlusion (e.g., bilateral MCA occlusion, MCA occlusion accompanied with basilar occlusion); * Glomerular filtration rate (GFR) \<30 mL/min or serum creatinine level \>2.5 mg/dL; * Suspected septic embolism or infective endocarditis; * Neutropenia (ANC \<1.5 × 109/L); * Known active or recurrent liver disease (including cirrhosis, hepatitis B and C; positive or indeterminate laboratory results), or alanine aminotransferase (ALT)/aspartate aminotransferase (AST) levels \>3 times the upper limit of normal (ULN) or total bilirubin \>2 times ULN; * History of malignancy other than basal cell carcinoma of the skin; * History or evidence of active or latent tuberculosis infection, or presence of tuberculosis risk factors including but not limited to: close contact with active tuberculosis patients within the past 12 months; * Any terminal illness such that the patient would not be expected to survive more than 1 year; * Pregnant women, nursing mothers, or reluctance to use effective contraceptive measures during the period of trial; * Unlikely to adhere to the trial protocol or follow-up; * Any condition that, in the judgment of the investigator could impose hazards to the patient if study therapy is initiated or affect the participation of the patient in the study; * Participation in other interventional clinical trials within the previous 3 months.