Abstract Number: Esoc2026a1739 Minocycline for Acute Basilar Artery Occlusion Stroke Undergoing Endovascular Treatment: A Randomized Clinical Trial

Abstract Background and aims Minocycline is a promising anti-inflammatory agent for improving futile recanalization, but whether it improves clinical outcomes in basilar-artery stroke patients treated with endovascular therapy (EVT) remains unclear. In this study, we aimed to assess the efficacy and safety of oral minocycline combined with EVT on outcomes in patients who had basilar-artery stroke. Methods The Minocycline for acute Ischemic Stroke undergoing endovascular Treatment due to Basilar artery occlusion (MIST-B) trial was a multicenter, randomized, open-label clinical trial with blinded outcome assessment in 12 Chinese hospitals. Adults with basilar-artery stroke no more than 24 hours after onset were randomized (1:1) to receive oral minocycline (200 mg loading, then 100 mg every 12 hours for 5 days) plus EVT or EVT alone. The primary efficacy outcome was the expanded National Institutes of Health Stroke Scale (e-NIHSS) score at day 5. Results From March 4, 2023, to March 4, 2025, 90 patients were randomized, and 86 were analyzed (mean age 61.7 years, 31.4% women). At day 5, mean e-NIHSS was 15.0 (SD 13.5) in the minocycline group and 17.2 (SD 16.9) in the control group (adjusted mean difference -2.44 95% CI -7.78 to 2.89; P = 0.37). Other efficacy and safety outcomes, including symptomatic intracranial hemorrhage within 24 hours, 90-day modified Rankin Scale, did not differ significantly. Conclusions These results did not provide evidence to support prescribing minocycline to improve early neurological outcomes in patients with acute basilar-artery stroke undergoing EVT. Larger trials of minocycline with extended treatment duration are warranted. Conflict of interest All other authors declare no competing interests.