Transcranial magnetic stimulation after thrombectomy for acute ischemic stroke

Effects of Transcranial Magnetic Stimulation After Endovascular Treatment for Acute Ischemic Stroke

This trial will try short sessions of continuous theta-burst transcranial magnetic stimulation (cTBS) to help recovery in adults who had an acute anterior-circulation ischemic stroke and successful endovascular thrombectomy.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 60 (estimated)
• Ages: 18 Years to 80 Years
• Sex: All
• Sponsor: Xijing Hospital (Academic / other)
• Locations: 1 site (Xi'an, Shaanxi)
• Trial ID: NCT06639360 on ClinicalTrials.gov

What this trial studies

This is a multicenter, randomized, double-blind, sham-controlled trial comparing active continuous theta-burst stimulation (cTBS) to a sham procedure in patients treated with endovascular thrombectomy for acute anterior-circulation ischemic stroke. Eligible adults (18–80) have terminal ICA or M1/M2 occlusions, ASPECTS ≥6 on early CT, NIHSS 6–25 before thrombectomy, pre-stroke mRS ≤1, and successful recanalization (mTICI >2b/3). Participants are randomized after thrombectomy and receive blinded active or sham transcranial magnetic stimulation with safety and functional outcomes measured during follow-up. The trial aims to determine whether early post-thrombectomy neuromodulation can improve neurologic recovery without adding unacceptable risks.

Who should consider this trial

Good fit: Ideal candidates are adults 18–80 with acute anterior-circulation ischemic stroke due to terminal ICA or M1/M2 occlusion, ASPECTS ≥6, NIHSS 6–25 before thrombectomy, pre-stroke mRS ≤1, and documented successful recanalization (mTICI >2b/3) who can give informed consent.

Not a fit: Patients with contraindications to TMS (e.g., metallic intracranial hardware, pacemakers, cochlear implants), epilepsy, acute hemorrhage, severe comorbid organ dysfunction, or severe preexisting neurological disease are unlikely to benefit or be eligible.

Why it matters

Potential benefit: If successful, cTBS could speed neurological recovery and improve functional outcomes after thrombectomy for acute ischemic stroke.

How similar studies have performed: Previous TMS studies in subacute and chronic stroke have shown mixed but sometimes promising signals for motor and functional recovery, while applying cTBS immediately after thrombectomy is relatively novel and not well tested.

Eligibility criteria

Inclusion Criteria:

1. Patients with acute anterior circulation ischemic stroke aged between 18 and 80 years old.
2. Imaging suggests that the infarction is caused by occlusion of the terminal portion of the internal carotid artery or the M1/M2 segment of the middle cerebral artery.
3. A head CT within 24 hours of onset indicates an ASPECT score ≥6, and meets the guideline-recommended criteria for thrombectomy.
4. Pre-stroke mRS score is ≤1.
5. NIHSS score before thrombectomy is between 6 and 25.
6. With vascular recanalization of mTICI \> 2b/3.
7. Informed consent form signed.

Exclusion Criteria:

1. Patients with contraindications to TMS treatment, such as those with metallic foreign objects in the head, pacemakers, implantable drug pumps, cochlear implants, etc.;
2. Patients with epilepsy, increased intracranial pressure, tumors, acute cerebral hemorrhage, or other severe neurological diseases, and those with severe functional impairment of organs such as the heart, liver, and kidneys;
3. Head CT/MRI indicates midline shift or significant mass effect, or patients planned for surgical intervention;
4. Head CT/MRI suggests acute cerebral infarction in both sides;
5. Patients who are pregnant or breastfeeding;
6. Patients with severe mental disorders or dementia who cannot cooperate with follow-up;
7. Patients with other severe diseases resulting in an expected survival of less than 90 days;
8. Patients who are participating in other interventional clinical studies within 30 days before the start of this study or after the onset of this condition;
9. Patients who cannot cooperate with informed consent.

Where this trial is running

Xi'an, Shaanxi

• Xijing Hospital — Xi'an, Shaanxi, China (Recruiting)

Study contacts

• Study coordinator: Jingjing Zhao, Dr.

Conditions Ischemic Stroke, Acute; Endovascular Thrombectomy