Inclusion Criteria1. Patients presenting with anterior circulation acute ischaemic stroke who are eligible for alteplase and mechanical thrombectomy commenced within 6 hours of stroke onset.
2. Patient, family member or legally responsible person depending on local ethics requirements has given informed consent.
3. Patient‟s age is 18-85 years.
4. Arterial occlusion on CTA of the ICA, M1 or M2.
5. Imaging inclusion criteria: infarct core volume between 15-100 mL with at least 20% mismatch (as evaluated by CTP).
Exclusion Criteria1. Standard contraindications to alteplase or mechanical thrombectomy.
2. Evidence of other diseases of the CNS.
3. Pre-existing neurologic disability (a score greater than 2 on the mRS).
4. Swallowing difficulties that would prevent administration of oral fingolimod.
5. Patients with any history of bradyarrhythmia, atrioventricular block or current use of beta-blockers or verapamil.
6. Patients with serious acute or chronic infection, or hepatic injury (over 3 times value of normal ALS or AST).
7. Concomitant use of antineoplastic, immunosuppressive or immune modulating therapies.
8. Macular edema.