Minocycline after successful reopening of posterior circulation stroke with endovascular therapy

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This multicenter, double-blind, randomized trial compares minocycline versus placebo in adults who have had a posterior circulation acute ischemic stroke and achieved successful recanalization after endovascular thrombectomy. Participants receive a loading dose of 200 mg minocycline orally, then 100 mg every 12 hours for 4 days, with dosing possible via feeding tube if needed. The primary outcome is functional independence at 90 days, defined as a modified Rankin Scale score of 0-2. A total of 234 participants (117 per arm) will be enrolled to determine safety and efficacy. Eligible patients include adults with acute posterior circulation stroke, confirmed occlusion, good pre-stroke function, and successful recanalization, while key exclusions address hemorrhage and multi-territory occlusions.

Why it matters

Who can join: the full rules

Inclusion Criteria:

1. Age ≥18 years;
2. Pre-stroke mRS score of 0-1;
3. Time from symptom onset to randomization ≤24 hours, including wake-up stroke or unwitnessed stroke. Symptom onset is defined as the last known well time;
4. Baseline NIHSS score ≥6;;
5. Posterior Circulation ASPECTS ≥6 on non-contrast CT or DWI;
6. Clinical symptoms attributable to acute occlusion of the intracranial vertebral artery or basilar artery, confirmed by CTA, MRA, or DSA;
7. Successful recanalization defined as mTICI 2b-3 after mechanical thrombectomy, with no evidence of secondary embolization in non-target vessels; or spontaneous improvement to mTICI 2b-3 on diagnostic angiography prior to thrombectomy with no planned intervention;
8. Ability of the patient or legally authorized representative to provide written informed consent.

Exclusion Criteria:

1. Acute intracranial hemorrhage on CT or MRI;
2. Occlusion involving both anterior and posterior circulations on CTA, MRA, or DSA (except in patients with a prior history of anterior circulation occlusion);
3. Complete bilateral thalamic infarction or bilateral brainstem infarction on CT or MRI;
4. Cerebellar infarction with significant mass effect or compression of the fourth ventricle on CT or MRI;
5. Vascular anatomy on CTA, MRA, or DSA that is severely tortuous, demonstrates significant anatomical variation, or shows severe stenosis or dissection precluding navigation of thrombectomy devices to the target vessel;
6. History of pseudomembranous colitis or antibiotic-associated colitis;
7. Known allergy to tetracycline antibiotics, any component of the investigational drug, radiocontrast agents, or nitinol materials;
8. Known resistance to tetracycline antibiotics;
9. Use of tetracycline antibiotics within 7 days prior to randomization;
10. History of intracranial hemorrhage within the past 3 months, including intraparenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, subdural hematoma, or epidural hematoma;
11. Intracranial tumors, vascular malformations, or other space-occupying intracranial lesions;
12. History of intracranial or spinal surgery within the past 3 months;
13. History of major surgery or significant trauma within the past 1 month;
14. Receipt of any of the following treatments within the past 3 months: systemic retinoic acid or androgen/antiandrogen therapy (e.g., anabolic steroids, spironolactone);
15. Platelet count \<100 × 10⁹/L;
16. Severe hepatic insufficiency, chronic hemodialysis, or severe renal insufficiency (defined as estimated glomerular filtration rate \<30 mL/min or serum creatinine \>265.2 μmol/L \[3.0 mg/dL\]);
17. Women who are pregnant or lactating, or who have a positive pregnancy test prior to randomization;
18. Life expectancy \<6 months (e.g., due to malignancy or severe cardiopulmonary disease);
19. Participation in another interventional clinical trial that may affect outcome assessment;
20. Any other condition that, in the investigator's judgment, makes the patient unsuitable for participation or poses significant risk (e.g., inability to understand or comply with study procedures or follow-up due to psychiatric, cognitive, or emotional disorders).

Where it's running

• Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
  Wuhan, Hubei, China Recruiting

Study contacts

• Principal investigator: Xiang Luo — Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 450001
• Study coordinator: Xiang Luo
• Email: flydottjh@163.com
• Phone: +86-13349893413

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.