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Ischemic Stroke, AcutePhase 4MIST-ANCT05487417

Effects of Minocycline on Patients With Ischemic Stroke Undergoing Intravenous Thrombectomy

A Phase 4 study testing Minocycline in people with Ischemic Stroke, Acute, run by Xijing Hospital at 1 site in China.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Minocycline is the second generation of tetracycline. Because of its lipophilicity, it has high penetrance of blood-brain barrier. Animal model studies have shown that minocycline can reduce cerebral damage after ischemic stroke, and its mechanism involves multiple molecular pathways, such as antioxidant… Read more about this study

Who is it for?
Ages 18 to 85 years
Conditions the study is for
Ischemic Stroke, Acute
What is being tested?
Minocycline
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
189 participants
Where
1 siteChina
Study dates
1 Nov 2022to 10 Sep 2025
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients with acute cerebral infarction of anterior circulation accompanied by large vessel occlusion;
  • Age 18-85 years old;
  • The time of onset ≤ 6 hours or ≤ 24 hours suitable for mechanical thrombectomy determined by multimodal imaging;
  • The time of onset 6-24 hours, DWI shows an infarct volume less than 1/3 of the MCA blood supply area; the time of onset ≤ 6 hours, the ASPECTS(Alberta Stroke Program Early CT Score) is ≥6;
  • Preoperative NIHSS score ranges from 6 to 30 points;
  • Sign the informed consent form;

Who cannot join

  • There are contraindications for mechanical thrombectomy;
  • No revascularization therapy was performed during the operation or the TICI score after revascularization therapy was less than 2b;
  • There are other major central nervous system diseases, such as brain injury, brain tumor, multiple sclerosis, etc;
  • There is evidence that the patient has bacterial endocarditis, aortic dissection, arteritis or venous cerebral infarction;
  • Renal insufficiency or hepatic insufficiency (serum creatinine >2.0 mg/dL or 180 µmol/L; liver function greater than 3 times the normal value);
  • Known history of congestive heart failure (requiring dietary or medication changes or hospitalization) within 6 months, or myocardial infarction within 6 months;
Show all 14Show fewer
  • There is evidence of any other life-threatening or severe diseases that may hinder the completion of the 3-month follow-up and affect the evaluation of the results;
  • Pre-existing neurological deficits or history of dementia;
  • There are infectious diseases that require antibiotic treatment before the disease;
  • Allergic to tetracyclines or unable to take minocycline for other reasons;
  • Minocycline could not be given within 1 hour after recanalization;
  • Pregnant patients;
  • Participated in another clinical trial within 30 days before inclusion in the study.
  • Refuse to sign the informed consent form.

Trial locations and contacts

1 site in 1 country.

China1 site

  • Xijing Hospital

    Xi'an

Other trials in China

About this study

Official title: Effects of Minocycline on Patients With Acute Anterior Circulation Ischemic Stroke Undergoing Intravenous Thrombectomy

Minocycline is the second generation of tetracycline. Because of its lipophilicity, it has high penetrance of blood-brain barrier. Animal model studies have shown that minocycline can reduce cerebral damage after ischemic stroke, and its mechanism involves multiple molecular pathways, such as antioxidant, anti-inflammatory, anti apoptotic pathways, and protection of blood-brain barrier. Clinical studies have also shown that minocycline can significantly improve 3-month National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) of patients with ischemic stroke, indicating that minocycline is a potential neuroprotective drug. Minocycline is believed to protect the blood-brain barrier, thereby reducing the ischemia-reperfusion injury caused by mechanical thrombectomy. However, whether minocycline can become a synergistic treatment method of mechanical thrombectomy, there is no clinical research in this area at present. Therefore, investigators carry out the study on the effect of minocycline in patients with acute anterior circulation ischemic stroke after mechanical thrombectomy, and plan to enroll 180 patients. To explore the safety and effectiveness of minocycline in patients with acute ischemic stroke after thrombectomy.

Being tested
Minocycline
Keywords
Ischemic Stroke, Minocycline, Mechanical thrombectomy, Anterior circulation, Neuroprotection
Medical subject headings
Ischemic Stroke, cyclopia sequence

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • MinocyclineDrug

    Minocycline is a tetracycline antibiotic. Previous studies have confirmed that its application in stroke patients has good efficacy and safety, suggesting that it could become a synergistic treatment of mechanical thrombectomy.

Study groups in NCT05487417
Study groupRoleWhat they receive
Minocycline treatment groupExperimentalPatients were given minocycline 200mg/d orally from the day of admission for 5 days. At the same time, the patient received mechanical thrombectomy and other standard treatments for acute ischemic stroke.
Receives: Drug: Minocycline
Routine treatment groupNo interventionPatients were given mechanical thrombectomy and other standard treatment for acute ischemic stroke, without minocycline treatment.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in infarct volume from baseline to day 5

    Baseline infarct volume is measured by diffusion-weighted imaging (DWI), day 5 infarct volume is measured by fluid attenuated inversion recovery (FLAIR), Images are processed by imSTROKE software.

    Measured: Day 5 after onset

Secondary outcomes (9)

  1. Functional outcome at 3 months after onset

    Defined by the modified Rankin Scale (mRS), which ranges from 0 (no symptoms) to 6 (death), analyzed for superiority and then for noninferiority.

    Measured: 3 months after onset

  2. Favourable outcome at 3 months after onset

    Defined as proportion of patients with modified Rankin Scale (mRS) 0-2, which ranges from 0 (no symptoms) to 6 (death), An mRS score of <3 indicated a favourable outcome, whereas a score of ≥3 indicated a poor outcome.

    Measured: 3 months after onset

  3. Excellent outcome at 3 months after onset

    Defined as proportion of patients with modified Rankin Scale (mRS) 0-1, which ranges from 0 (no symptoms) to 6 (death), An mRS score of <2 indicated a excellent outcome, whereas a score of ≥2 indicated a poor outcome.

    Measured: 3 months after onset

  4. Improvement of neurological function compared with baseline

    Defined by the National Institute of Health Stroke Scale (NIHSS), which ranges from 0 (no neurological injury) to 42 (severe neurological injury). The assessment time points were baseline, day 1, day 3, day 5, day 7, and 3 months after onset.

    Measured: day 1, day 3, day 5, day 7, and 3 months after onset

  5. Improvement of activity of daily living at 3 months after onset

    Defined by Barthel index (BI), which ranges from 0 (completely lose the ability to live independently) to 100 (complete ability to live independently). The assessment time points were 3 months after onset

    Measured: 3 months after onset

  6. Incidence of intracranial hemorrhage at day 1 after onset

    Intracranial hemorrhage is measured by CT scan. Images are processed by RAPID ICH software.

    Measured: Day 1 after onset

  7. Mortality at 3 months after onset

    The investigators record all-cause mortality

    Measured: 3 months after onset

  8. Infarct volume at day 5 after onset

    Day 5 infarct volume is measured by fluid attenuated inversion recovery (FLAIR). Images are processed by imSTROKE software.

    Measured: Day 5 after onset

  9. Length of hospital stay and length of Intensive Care Unit (ICU) stay

    How long the patients stay in hospital, and how long the patients stay in ICU

    Measured: 3 months after onset

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Aug 2022
  2. Study start1 Nov 2022
  3. Primary completion10 Jun 2025
  4. Study completion10 Sep 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
189 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05487417
Sponsor's protocol ID
XJLL-KY20222186
Acronym
MIST-A
Status last verified
Jul 2026
First submitted
30 Jul 2022
Last updated
29 Jul 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008 Sep 25;359(13):1317-29. doi: 10.1056/NEJMoa0804656.

    PubMed 18815396

  • Yenari MA, Xu L, Tang XN, Qiao Y, Giffard RG. Microglia potentiate damage to blood-brain barrier constituents: improvement by minocycline in vivo and in vitro. Stroke. 2006 Apr;37(4):1087-93. doi: 10.1161/01.STR.0000206281.77178.ac. Epub 2006 Feb 23.

    PubMed 16497985

  • Matsukawa N, Yasuhara T, Hara K, Xu L, Maki M, Yu G, Kaneko Y, Ojika K, Hess DC, Borlongan CV. Therapeutic targets and limits of minocycline neuroprotection in experimental ischemic stroke. BMC Neurosci. 2009 Oct 6;10:126. doi: 10.1186/1471-2202-10-126.

    PubMed 19807907

  • Liao TV, Forehand CC, Hess DC, Fagan SC. Minocycline repurposing in critical illness: focus on stroke. Curr Top Med Chem. 2013;13(18):2283-90. doi: 10.2174/15680266113136660160.

    PubMed 24059465

  • Yang Y, Salayandia VM, Thompson JF, Yang LY, Estrada EY, Yang Y. Attenuation of acute stroke injury in rat brain by minocycline promotes blood-brain barrier remodeling and alternative microglia/macrophage activation during recovery. J Neuroinflammation. 2015 Feb 10;12:26. doi: 10.1186/s12974-015-0245-4.

    PubMed 25889169

  • Muhammad S, Planz O, Schwaninger M. Increased Plasma Matrix Metalloproteinase-9 Levels Contribute to Intracerebral Hemorrhage during Thrombolysis after Concomitant Stroke and Influenza Infection. Cerebrovasc Dis Extra. 2016;6(2):50-9. doi: 10.1159/000447750. Epub 2016 Aug 25.

    PubMed 27560521

  • Fagan SC, Waller JL, Nichols FT, Edwards DJ, Pettigrew LC, Clark WM, Hall CE, Switzer JA, Ergul A, Hess DC. Minocycline to improve neurologic outcome in stroke (MINOS): a dose-finding study. Stroke. 2010 Oct;41(10):2283-7. doi: 10.1161/STROKEAHA.110.582601. Epub 2010 Aug 12.

    PubMed 20705929

  • Lampl Y, Boaz M, Gilad R, Lorberboym M, Dabby R, Rapoport A, Anca-Hershkowitz M, Sadeh M. Minocycline treatment in acute stroke: an open-label, evaluator-blinded study. Neurology. 2007 Oct 2;69(14):1404-10. doi: 10.1212/01.wnl.0000277487.04281.db.

    PubMed 17909152

  • Elkins J, Veltkamp R, Montaner J, Johnston SC, Singhal AB, Becker K, Lansberg MG, Tang W, Chang I, Muralidharan K, Gheuens S, Mehta L, Elkind MSV. Safety and efficacy of natalizumab in patients with acute ischaemic stroke (ACTION): a randomised, placebo-controlled, double-blind phase 2 trial. Lancet Neurol. 2017 Mar;16(3):217-226. doi: 10.1016/S1474-4422(16)30357-X. Epub 2017 Feb 15.

    PubMed 28229893

  • Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, Yavagal DR, Ribo M, Cognard C, Hanel RA, Sila CA, Hassan AE, Millan M, Levy EI, Mitchell P, Chen M, English JD, Shah QA, Silver FL, Pereira VM, Mehta BP, Baxter BW, Abraham MG, Cardona P, Veznedaroglu E, Hellinger FR, Feng L, Kirmani JF, Lopes DK, Jankowitz BT, Frankel MR, Costalat V, Vora NA, Yoo AJ, Malik AM, Furlan AJ, Rubiera M, Aghaebrahim A, Olivot JM, Tekle WG, Shields R, Graves T, Lewis RJ, Smith WS, Liebeskind DS, Saver JL, Jovin TG; DAWN Trial Investigators. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2018 Jan 4;378(1):11-21. doi: 10.1056/NEJMoa1706442. Epub 2017 Nov 11.

    PubMed 29129157

  • Zhang X, Wei D, Li Y, Zhang H, Yao L, Yuan X, Liu W, Ma X, Wang B, Qin N, Li D, Shi R, Fan Z, Wang X, Wang L, Liu Z, Wang L, Wang D, Zhao J, Jiang W; MIST-A Study Group. Efficacy and safety of minocycline on patients with acute anterior circulation ischaemic stroke undergoing mechanical thrombectomy (MIST-A): a multicentre, prospective, randomised, open-label, blinded-endpoint, phase 2 trial. Lancet Reg Health West Pac. 2026 Jun 5;71:101898. doi: 10.1016/j.lanwpc.2026.101898. eCollection 2026 Jun.

    PubMed 42305108

  • Zhang X, Zhao J, Sun Z, Wei D, Yao L, Li W, Zhu H, Liu W, Zhang H, Yuan X, Ma X, Meng J, Wang B, Jia Y, Qin N, Jiang W; MIST-A Study Group. Effects of minocycline on patients with acute anterior circulation ischaemic stroke undergoing intravenous thrombectomy (MIST-A): the study protocol for a multicentre, prospective, randomised, open-label, blinded-endpoint trial. BMJ Open. 2024 Dec 20;14(12):e093443. doi: 10.1136/bmjopen-2024-093443.

    PubMed 39806586

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Minocycline in people with Ischemic Stroke, Acute, run by Xijing Hospital at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in infarct volume from baseline to day 5 (time frame: Day 5 after onset). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05487417, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Jul 2026.

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