Efficacy and Safety of Interleukin-6 Receptor Inhibitor Combined With Endovascular Treatment in Patients With Acute Posterior Circulation Large Vessel Occlusion Stroke

Prior treatment

• Concurrent malignant tumors or severe systemic diseases with expected survival of less than 90 days;
• Participation in another interventional clinical study within 30 days before randomization or currently participating in another interventional clinical study;
• Any circumstance that, as assessed by the investigators, might result in harm to the patients if study therapy is initiated;

Other illness

• Intracerebral hemorrhage, epidural hematoma, subdural hematoma, intraventricular hemorrhage, or subarachnoid hemorrhage;
• Pre-stroke modified Rankin scale (mRS) score \>1;
• Known allergy to tocilizumab or excipients;
• Known allergy to iodinated contrast agents;
• History of congenital or acquired bleeding disorders, coagulation factor deficiency diseases, or thrombocytopenic diseases;
• Severe mental disorders or inability to comply with informed consent and follow-up requirements due to dementia;
• Presence of autoimmune diseases or use of immunosuppressive drugs;
• Systemic infectious diseases;
• Other conditions that the investigator considers might affect compliance or preclude participation in this study.

Lab values

• Neutrophils \< 2 × 10\^9 /L;
• Platelets \< 100 × 10\^9 /L;
• Blood glucose \<2.8 mmol/L (50 mg/dL) or \>22.2 mmol/L (400 mg/dL);
• Serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels \>2 times the upper limit of normal;
• Known recent or current serum creatinine \>2 times the upper limit of normal or estimated glomerular filtration rate (eGFR) \<60 mL/min;

Other

• Anticipated difficulty in completing endovascular treatment due to vascular tortuosity;
• Systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥110 mmHg despite blood pressure control;
• Pregnant, lactating, or planning pregnancy within 90 days;

• Age 18 years or older, of either sex;
• Acute ischemic stroke caused by occlusion of the basilar artery;
• Decide to undergo emergency endovascular treatment;
• Time from stroke onset to groin puncture within 24 hours;
• National Institutes of Health Stroke Scale (NIHSS) ≥ 10;
• Posterior circulation Alberta Stroke Program Early computed tomography score (pc-ASPECTS) ≥ 6;
• Signed informed consent from the patients or the legally authorized representatives.