Efficacy and Safety of Interleukin-6 Receptor Inhibitor Combined With Endovascular Treatment in Patients With Acute Posterior Circulation Large Vessel Occlusion Stroke

This is an investigator-initiated, prospective, multicenter phase III clinical trial. This trial aims to investigate whether tocilizumab could further improve prognosis for patients with acute posterior circulation large-vessel occlusion stroke receiving endovascular therapy.

Inclusion criteria

• Age 18 years or older, of either sex;
• Acute ischemic stroke caused by occlusion of the basilar artery;
• Decide to undergo emergency endovascular treatment;
• Time from stroke onset to groin puncture within 24 hours;
• National Institutes of Health Stroke Scale (NIHSS) ≥ 10;
• Posterior circulation Alberta Stroke Program Early computed tomography score (pc-ASPECTS) ≥ 6;
• Signed informed consent from the patients or the legally authorized representatives.

Exclusion criteria

• Intracerebral hemorrhage, epidural hematoma, subdural hematoma, intraventricular hemorrhage, or subarachnoid hemorrhage;
• Pre-stroke modified Rankin scale (mRS) score >1;
• Known allergy to tocilizumab or excipients;
• Known allergy to iodinated contrast agents;
• Anticipated difficulty in completing endovascular treatment due to vascular tortuosity;
• History of congenital or acquired bleeding disorders, coagulation factor deficiency diseases, or thrombocytopenic diseases;
• Systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥110 mmHg despite blood pressure control;
• Neutrophils < 2 × 10^9 /L;
• Platelets < 100 × 10^9 /L;
• Blood glucose <2.8 mmol/L (50 mg/dL) or >22.2 mmol/L (400 mg/dL);
• Serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels >2 times the upper limit of normal;
• Known recent or current serum creatinine >2 times the upper limit of normal or estimated glomerular filtration rate (eGFR) <60 mL/min;
• Pregnant, lactating, or planning pregnancy within 90 days;
• Severe mental disorders or inability to comply with informed consent and follow-up requirements due to dementia;
• Concurrent malignant tumors or severe systemic diseases with expected survival of less than 90 days;
• Presence of autoimmune diseases or use of immunosuppressive drugs;
• Systemic infectious diseases;
• Participation in another interventional clinical study within 30 days before randomization or currently participating in another interventional clinical study;
• Any circumstance that, as assessed by the investigators, might result in harm to the patients if study therapy is initiated;
• Other conditions that the investigator considers might affect compliance or preclude participation in this study.