Low-Frequency REpetitive TRanscranial Magnetic Stimulation Combined With Endovascular Treatment in ACute Ischemic StrokE

Prior treatment

• TMS contraindications include metallic foreign bodies in the head, pacemaker, implantable drug pumps, cochlear implants, etc.
• Before the bridging therapy, other thrombolytic drugs besides alteplase or tenecteplase were used;
• Participants in other clinical intervention studies within 30 days before randomization or who were participating in other clinical intervention studies.

Other illness

• Epilepsy or history of epilepsy, intracranial hypertension, tumor and other serious neurological disorders;
• Evidence of acute intracranial hemorrhage;
• A history of congenital or acquired hemorrhagic disease, coagulation factor deficiency, or thrombocytopenia disease;
• Patients with severe mental disorders or dementia who can not cooperate with informed consent and follow-up;
• Patients with malignancy or severe systemic disease and expected survival of less than 90 days;

Lab values

• Known recent or current serum creatinine exceeding 1.5 times the upper limit of normal or estimated glomerular filtration rate (EGFR) \< 60 mL/min;

Other

• Midline displacement and brain parenchymal mass effect seen in head CT and other images;
• Head CT or MRI showed bilateral acute cerebral infarction;
• CT or MRI showed a large area of infarction (\> 1/3 of the area supplied by middle cerebral artery);
• After blood pressure control, the systolic blood pressure was still ≥180 mmHg or the diastolic blood pressure was ≥110 mmHg;
• Patients during pregnancy or lactation and within 90 days of planned pregnancy;

• 18 - 80 years, male or female;
• Clinically diagnosed as acute anterior ischemic stroke, artery occlusion occurred at the terminal of the intracranial carotid artery, T-shaped bifurcation or M1 segment of the middle cerebral artery;
• Within 24 hours of stroke onset;
• Eligible for other imaging indications for bridging therapy or direct mechanical thrombectomy:
  • ASPECTS ≥6 certified by the latest brain CT imaging; Patients within 6-16 hours after stroke onset should meet the mismatch criteria, which was defined as infarction core volume \<70 ml, mismatch ratio ≥1.8 and the ischemic volume \> 15 ml (DEFUSE-3 Criteria); or NIHSS score ≥ 10 with infarction -core volume \< 31 cm3, or NIHSS score ≥ 20 with infarction core volume ≤ 51 cm3 (DAWN Criteria); Patients within 16-24 hours after stroke onset should meet the mismatch criteria, which was defined as NIHSS score ≥ 10 with infarction-core volume \< 31 cm3, or NIHSS score ≥ 20 with infarction-core volume ≤ 51 cm3 (DAWN Criteria);
• Planned to receive bridging therapy (endovascular therapy after intravenous alteplase) or direct endovascular therapy;
• Pre-morbid modified Rankin Scale ≤1;
• 6 ≤ NIHSS ≤ 25 before endovascular therapy;
• Signed informed consent from subjects or legally authorized representatives