Abstract Body: Background and Aims: Whether immediate angioplasty for acute ischemic stroke with severe intracranial atherosclerotic stenosis (AIS-ICAS) can improve functional outcomes remains unknown. We aim to assess the efficacy and safety of immediate angioplasty for patients with AIS-ICAS.

Methods: MAGIC is an investigator-initiated, adaptive, multicenter, prospective, randomized controlled, open-label, blinded endpoint (PROBE) trial (NCT06437600). Patients with AIS attributed to severe ICAS (70-99%) and NIHSS ≥6 within 24 hours of symptom onset will be screened for eligibility. Eligible participants are randomly assigned 1:1 to receive either immediate angioplasty (with or without stenting) or only standard medical treatment. The primary outcome is the proportion of the 90-day modified Rankin Scale of 0-2. MAGIC was designed to test a 15% difference (50% vs 35%) in the proportion of functional independence with a planned sample size of 412 subjects. After 50% of the planned sample size completes the study, an interim analysis will be conducted to determine the continuation of the study and the final sample size will be re-estimated.

Results: This study has been approved by the Ethics Committee of Sun Yat-sen Memorial Hospital and will receive approval from all participating centers. MAGIC is expected to be conducted at ~30 stroke centers in China. At the time of submitting this abstract, no participant is randomized, and the study is expected to be completed by the end of 2029.

Conclusions: MAGIC will provide robust evidence of immediate angioplasty for AIS-ICAS in improving functional outcomes.