This phase 2, multicenter, randomized, double-blind, placebo-controlled trial will evaluate the efficacy and safety of anisodine hydrobromide in patients with acute ischemic stroke undergoing endovascular thrombectomy.
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Inclusion Criteria: * Age 18-80 years * Anterior-circulation large-vessel occlusion involving the intracranial ICA, M1, or proximal/dominant M2 * Eligible for endovascular treatment within 24 hours of last known well * Baseline NIHSS score ≥6 * Baseline ASPECTS ≥6 * Pre-stroke mRS score 0-1 * Written informed consent provided by the participant or legally authorized representative Exclusion Criteria: * Intracranial hemorrhage on baseline imaging * Significant bleeding disorder or coagulopathy * Vascular anatomy unsuitable for EVT * Pregnancy, breastfeeding, or planned pregnancy within 90 days * Known hypersensitivity or severe intolerance to anisodine hydrobromide * Contraindication to anticholinergic drugs * Severe arrhythmia or hemodynamic instability * Severe psychiatric disorder, dementia, or impaired consciousness precluding consent or follow-up * Malignancy or other severe systemic disease with a life expectancy \<90 days * Participation in another clinical trial within 30 days before enrollment or concurrently * Any condition that, in the investigator's opinion, makes the patient unsuitable for study participation