Footnotes

• MZ and PX are joint first authors.

• LZ and JF contributed equally.

• Collaborators DIRECT-MT Investigators- Executive Committee: Prof. Jianmin Liu, Department of Neurosurgery, Naval Medical University Changhai hospital, Shanghai, China. Prof. Benqiang Deng, Department of Neurology, Naval Medical University Changhai hospital, Shanghai, China. Prof. Bo Hong, Department of Neurosurgery, Naval Medical University Changhai hospital, Shanghai, China. Prof. Kaifu Ke, Department of Neurology, Affiliated Hospital of Nantong University, Nantong, China. Prof. Min Lou, Department of Neurology, Second Affiliated Hospital of Zhejiang University, Hangzhou, China. Prof. Congguo Yin, Department of Neurology, Hangzhou First People's Hospital of Zhejiang University, Hangzhou, China. Prof. Peng Wang, Department of Neurology, Taizhou First People's Hospital of Wenzhou Medical University, Taizhou, China. Prof. Wenhuo Chen, Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China. Prof. Anding Xu, Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou, China. Prof. Tianxiao Li, Department of Radiology, Henan Provincial People’s Hospital of Zhengzhou University, Zhengzhou, China Prof. Liping Wei, Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang, China. Prof. Conghui Li, Department of Neurosurgery, First Hospital of Hebei Medical University, Shijiazhuang, China. Prof. Qiyi Zhu, Department of Neurology, Linyi People’s Hospital of Qingdao University, Linyi, China. Prof. Dianjing Sun, Department of Radiology, Yantaishan Hospital of Shandong First Medical University, Yantai, China. Prof. Hui Liang, Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai, China. Prof. Jiyue Wang, Department of Neurosurgery, Liaocheng People’s Hospital of Shandong First Medical University, Liaocheng, China Prof. Shouchun Wang, Department of Neurology, First Affiliated Hospital of Jilin University, Changchun, China. Prof. Ya Peng, Department of Neurosurgery, Third Affiliated Hospital of Soochow University, Changzhou, China. Prof. Yun Xu, Department of Neurology, Nanjing Drum Tower Hospital of Nanjing University, Nanjing, China. Prof. Hongchao Shi, Department of Neurology, Nanjing First Hospital of Nanjing Medical University, Nanjing, China. Prof. Qi Fang, Department of Neurology, First Affiliated Hospital of Soochow University, Suzou, China. Prof. Haibin Shi, Department of Radiology, Jiangsu Provincial People’s Hospital of Nanjing Medical University, Nanjing, China. Prof. Meng Zhang, Department of Neurology, Daping Hospital of Army Medical University, Chongqing, China. Prof. Shengli Chen, Department of Neurology, Chongqing Three Gorges Central Hospital, Chongqing, China Prof. Tong Li, Department of Neurology, Third Affiliated Hospital of Guangxi Medical University, Nanning, China. Prof. Xincan Yue, Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou, China. Prof. Huaizhang Shi, Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, China. Prof. Changchun Jiang, Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University, Baotou, China. Prof. Guoping Wang, Department of Neurology, First Affiliated Hospital of University of Science and Technology of China (USTC), Hefei, China.

• Contributors MZ and PX are co-first authors and contributed equally to the work. Conception or design of the article: MZ, PX, LZ, JF, and JL. Drafting of the manuscript: MZ and PX. Acquisition, analysis, or interpretation of data: JT, LS, PY, YZ, LZ, YP, SL. Revision of the manuscript for important intellectual content: All authors. Final approval of the version: LZ, JF, and JL.The author acting as guarantor：JF.

• Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

• Competing interests None declared.

• Provenance and peer review Not commissioned; externally peer reviewed.

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