A randomized placebo-controlled double-blind trial phase II two-arm study to investigate infarct growth over 72 hours assessed with diffusion weighted imaging on MRI after treatment with intravenous tocilizumab or placebo in patients above 18 years of age with acute ischemic stroke undergoing endovascular thrombectomy.

Prior treatment

• Known prior receipt of tocilizumab for any reason, including prior enrolment in this trial.

Other illness

• Any intracranial haemorrhage during the qualifying imaging.

Lab values

• Known thrombocytopenia (platelet count <100 × 10³/µL), neutropenia, or elevated liver enzymes (ALT or AST >1.5 × the upper limit of normal [ULN]).
• Known hypersensitivity to tocilizumab or any of the excipients listed in section 6.1 of the SmPC: Sucrose, Polysorbate 80 (E 433), Disodium phosphate dodecahydrate (for pH adjustment), Sodium dihydrogen phosphate dihydrate (for pH adjustment) and water for injections.
  • Pregnancy/Lactation; female, with positive urine or serum beta human chorionic gonadotropin (β-hCG) test, or breastfeeding.
  • Malignancies, ongoing infection, immunodeficiency, or any suspicion of acute infection.
  • Clinical history, past imaging or clinical judgment suggesting that the intracranial occlusion is chronic, or there is suspected intracranial dissection such that there is a predicted lack of success with endovascular intervention.
  • Endovascular thrombectomy procedure is completed as defined by the presence of TICI 2c/3 reperfusion or completion of groin / arterial closure
  • Patients receiving immunosuppressive drugs other than prednisolone ≤ 10 mg/day.

Other

• Contraindications to MRI.
• Absent or poor collateral circulation during qualifying imaging.
• Large core of established infarction (ASPECTS 0-2).
• Systolic blood pressure > 185 mmHg or diastolic blood pressure > 110 mmHg at baseline, despite appropriate medical management.

• Participant must be above 18 years of age at the time of signing the informed consent.
• Participants who have acute ischemic stroke selected for emergency endovascular treatment according to treatment guidelines.
• Onset of stroke symptoms (last-known-well) time to randomization time within 12 hours.
• Large vessel occlusion in the anterior circulation (terminal internal carotid artery, M1 or M2 segment of MCA. Tandem extracranial carotid and intracranial occlusions are permitted).
• Women of childbearing potential (WOCBP) can only be included if they use a highly effective contraception method as defined in Appendix 4 of the protocol.
• Capable of giving signed informed consent or given by legal representative as described in Appendix I, section 10.1.2., including compliance with the requirements and restrictions listed in the informed consent form (ICF) and in this protocol.