Effect of Interleukin-6 Receptor Inhibition in Patients With Ischemic Stroke Undergoing Endovascular Treatment

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• Inclusion criteria:
  • Age 18-80 years.
  • Acute ischemic stroke caused by occlusion of intracranial segment of the internal carotid artery, middle cerebral artery M1, or M2 segment.
  • NIHSS ≥ 6.
  • Meeting the criteria of endovascular treatment:
  • ① ASPECTS score ≥ 6, possibile to start endovascular treatment within 6 hours from stroke onset.
  • ② Stroke onset between 6-16 hours, meeting DEFUSE-3 criteria (infarct core volume \< 70ml, mismatch ratio ≥ 1.8, and mismatch volume \> 15ml), or DAWN criteria (NIHSS ≥ 10 and infarct core volume \< 31ml; or NIHSS ≥ 20 and infarct volume 31-51ml).
  • ③ Stroke onset between 16-24 hours, meeting DAWN criteria (NIHSS ≥ 10 and infarct core volume \< 31ml; or NIHSS ≥ 20 and infarct volume 31-51ml).
  • ④ When ASPECTS score is \< 6, meeting RESCUE-Japan LIMIT criteria (ASPECTS score 3-5; stroke onset within 6 hours or between 6-24 hours but no acute stroke signs on FLAIR), or ANGEL-ASPECT criteria (stroke onset within 24 hours, ASPECTS 3-5; or onset within 24 hours, ASPECTS 0-2 and infarct core volume 70-100 mL; or onset between 6-24 hours, ASPECTS \> 5 and infarct core volume 70-100 mL), or SELECT2 criteria (ASPECTS 3-5; or infarct core volume greater than 50ml).
  • Experimental drug administration had to be possible within 24 hours after stroke onset.
  • Obtained Informed consent from the patient or their legal representative.
• Exclusion Criteria:
  • Hemorrhagic diseases visible on head CT: hemorrhagic stroke, epidural hematoma, subdural hematoma, intraventricular hemorrhage, subarachnoid hemorrhage, etc.
  • Pre-stroke mRS score \> 1.
  • Known allergy to tocilizumab or excipients.
  • Known allergy to iodinated contrast agents.
  • Anticipated difficulty in completing endovascular treatment due to vascular tortuosity.
  • History of congenital or acquired bleeding disorders, coagulation factor deficiency diseases, thrombocytopenic diseases, etc.
  • Systolic blood pressure ≥ 180 mmHg or diastolic blood pressure ≥ 110 mmHg despite blood pressure control.
  • Neutrophil \< 2×10 9/L.
  • Platelet \< 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 greater than 1.5 times the upper limit of normal.
  • Known recent or current serum creatinine exceeding 1.5 times the upper limit of normal or estimated glomerular filtration rate (eGFR) \< 60 mL/min.
  • Pregnant, lactating, or planning pregnancy within 90 days.
  • Severe mental disorders or inability to comply with informed consent and follow-up requirements due to dementia.
  • Concurrent malignant tumors or severe systemic diseases with an expected survival of less than 90 days.
  • Presence of autoimmune diseases or use of immunosuppressive drugs.
  • Systemic infectious diseases
  • Participation in another interventional clinical study within 30 days before randomization or currently participating in another interventional clinical study.