Minocycline After Successful Endovascular Thrombectomy Recanalization in Posterior Circulation Arterial Occlusion (ATTRACTION-MINOP)

NCT07594301 | Recruiting Phase 2 DMC

• 1 other identifier: TJ-IRB202605010
• Study Type: interventional
• Target: 234
• Locations: 1 country
• Sites: 1

Brief Summary

Acute ischemic stroke (AIS) is a leading cause of mortality and long-term disability worldwide. Among these, stroke caused by large vessel occlusion (LVO) are associated with particularly poor outcomes. Multiple randomized controlled trials have demonstrated that endovascular thrombectomy (EVT) significantly improves clinical outcomes in patients with acute LVO and is recommended as the standard of care by current guidelines. Posterior circulation strokes account for approximately 20% of all ischemic strokes and are generally associated with worse prognosis than anterior circulation strokes, especially in patients with basilar artery occlusion, who have a markedly increased risk of death or severe disability. Despite EVT treatment, more than three-quarters of these patients remain dead or functionally dependent at 90 days, indicating substantial room for improvement. Successful recanalization and restoration of effective cerebral perfusion are critical for achieving favorable outcomes. However, although recanalization rates exceed 80% with current thrombectomy techniques, fewer than 40 of patients achieve good functional outcomes at 90 days, suggesting a high incidence of futile recanalization. The underlying mechanisms may include no-reflow, reperfusion injury, and microcirculatory dysfunction, all of which are closely associated with post-recanalization neuroinflammation. Minocycline is a second-generation tetracycline with pleiotropic neuroprotective properties, including inhibition of microglial activation, reduction of inflammatory mediators, suppression of matrix metalloproteinases, attenuation of oxidative stress, and preservation of blood-brain barrier integrity. Preclinical and clinical studies suggest that minocycline may improve neurological outcomes in patients with AIS. This study is a multicenter, prospective, double-blind, randomized controlled trial designed to evaluate the safety and efficacy of adjunctive minocycline in patients with acute posterior circulation arterial occlusion who achieve successful recanalization after EVT. The trial will assess whether early administration of minocycline improves functional outcomes and reduces the incidence of futile recanalization.

Conditions

Acute Ischemic Stroke; Minocycline; Endovascular Thrombectomy; Posterior Circulation; Arterial Occlusion

Keywords

Acute Ischemic Stroke; Endovascular Thrombectomy; Minocycline; Posterior Circulation Arterial Occlusion

Outcome Measures

Primary Outcomes (1)

• Functional independence

  Rate of mRS 0-2 at 90±7 days Defined as an modified Rankin Scale (mRS) score of 0 to 2. The mRS scores range from 0 (no symptoms) to 5 (severe disability) and 6 (death).

  90±7 days

Secondary Outcomes (5)

• Ordinal distribution of mRS

  90±7 days

• Excellent outcome

  90±7 days

• Ambulatory or bodily needs-capable or better

  90±7 days

• Quality of life (EQ-5D-5L)

  90±7 days

• Neurologic deficit (NIHSS score) changes

  24±12 hours and 6±1 days

Other Outcomes (4)

• Symptomatic intracranial hemorrhage (sICH)

  24±12 hours and 6±1 days

• All-caused mortality

  90±7 days

• Any intracranial hemorrhage

  24±12 hours and 6±1 days

Study Arms (2)

Minocycline group

EXPERIMENTAL

Participants with successful recanalization (mTICI 2b/3) after endovascular thrombectomy will receive minocycline as soon as possible after randomization. A loading dose of 200 mg of minocycline administered orally, followed by a maintenance dose of 100 mg every 12 hours for 4 days (total of 9 doses). For patients with swallowing dysfunction, administration via a feeding tube will be permitted.

Drug: Minocycline hydrochloride capsule

placebo group

PLACEBO COMPARATOR

Participants with successful recanalization (mTICI 2b/3) after endovascular thrombectomy will receive placebo as soon as possible after randomization. Placebo was administered in the same manner as minocycline group.

Drug: Placebo capsules of Minocycline hydrochloride capsules

Interventions

Minocycline hydrochloride capsule DRUG

50 mg per capsule, containing 50mg of Minocycline Hydrochloride.

Minocycline group

Placebo capsules of Minocycline hydrochloride capsules DRUG

50 mg per capsule, containing 0mg of Minocycline Hydrochloride.

placebo group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age ≥18 years;
• Pre-stroke mRS score of 0-1;
• 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;
• Baseline NIHSS score ≥6;;
• Posterior Circulation ASPECTS ≥6 on non-contrast CT or DWI;
• Clinical symptoms attributable to acute occlusion of the intracranial vertebral artery or basilar artery, confirmed by CTA, MRA, or DSA;
• 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;
• Ability of the patient or legally authorized representative to provide written informed consent.

You may not qualify if:

• Acute intracranial hemorrhage on CT or MRI;
• Occlusion involving both anterior and posterior circulations on CTA, MRA, or DSA (except in patients with a prior history of anterior circulation occlusion);
• Complete bilateral thalamic infarction or bilateral brainstem infarction on CT or MRI;
• Cerebellar infarction with significant mass effect or compression of the fourth ventricle on CT or MRI;
• 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;
• History of pseudomembranous colitis or antibiotic-associated colitis;
• Known allergy to tetracycline antibiotics, any component of the investigational drug, radiocontrast agents, or nitinol materials;
• Known resistance to tetracycline antibiotics;
• Use of tetracycline antibiotics within 7 days prior to randomization;
• History of intracranial hemorrhage within the past 3 months, including intraparenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, subdural hematoma, or epidural hematoma;
• Intracranial tumors, vascular malformations, or other space-occupying intracranial lesions;
• History of intracranial or spinal surgery within the past 3 months;
• History of major surgery or significant trauma within the past 1 month;
• Receipt of any of the following treatments within the past 3 months: systemic retinoic acid or androgen/antiandrogen therapy (e.g., anabolic steroids, spironolactone);
• Platelet count \<100 × 10⁹/L;

Sponsors & Collaborators

• Xiang Luo: lead

Study Sites (1)

Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology

Wuhan, Hubei, 430000, China

RECRUITING

Related Publications (1)

• Lu Y, Guan L, Wu J, Yang Q, Zhang M, Zhou D, Yang H, Pan Y, Wang L, Qiu B, Liu C, Wang Y, Yang Y, Zhou X, Qu H, Liao X, Liu L, Zhao X, Bath PM, Johnston SC, Amarenco P, Turc G, Shi FD, Wang Y, Wang Y; EMPHASIS Investigators. Efficacy and safety of minocycline in patients with acute ischaemic stroke (EMPHASIS): a multicentre, double-blind, randomised controlled trial. Lancet. 2026 Feb 14;407(10529):679-688. doi: 10.1016/S0140-6736(25)01862-8. Epub 2026 Jan 30.

  PMID: 41628627 BACKGROUND

MeSH Terms

Conditions

Ischemic Stroke; cyclopia sequence; Arterial Occlusive Diseases

Interventions

Minocycline

Condition Hierarchy (Ancestors)

Stroke; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases

Intervention Hierarchy (Ancestors)

Tetracyclines; Naphthacenes; Polycyclic Aromatic Hydrocarbons; Hydrocarbons, Aromatic; Hydrocarbons, Cyclic; Hydrocarbons; Organic Chemicals; Polycyclic Compounds

Study Officials

• Xiang Luo

  Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 450001

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Xiang Luo

CONTACT

+86-13349893413; flydottjh@163.com

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Masking Details: The Minocycline drug used in the study is indistinguishable from the Minocycline placebo (the shape, color, and appearance are identical). In addition, to ensure the blind method, the drug packaging and batch numbers of the two groups are identical, and the packaging batch numbers are uniformly marked.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: May 12, 2026
• First Posted: May 18, 2026
• Study Start: May 19, 2026
• Primary Completion (Estimated): December 1, 2028
• Study Completion (Estimated): December 1, 2028
• Last Updated: May 22, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)