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In this study, we aimed to assess the efficacy and safety of oral minocycline combined with EVT on outcomes in patients who had basilar-artery stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Minocycline for acute Ischemic Stroke undergoing endovascular Treatment due to Basilar artery occlusion (MIST-B) trial was a multicenter, randomized, evaluator-blinded, open-label, pilot trial in 12 Chinese hospitals. Adults with basilar-artery stroke no more than 24\u00a0h after onset were randomized (1:1) to receive oral minocycline (200\u00a0mg loading, then 100\u00a0mg every 12\u00a0h for 5 days) plus EVT or EVT alone. The primary efficacy outcome was the expanded National Institutes of Health Stroke Scale (e-NIHSS) score at day 5; the primary safety outcome was symptomatic intracranial hemorrhage (sICH) within 24\u00a0h. Participants were followed up 90 days after randomization. Modified intention-to-treat analysis examined treatment effect for the primary efficacy outcome using linear mixed models, with the baseline measurement of e-NIHSS score as a covariate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From March 4, 2023, to March 4, 2025, 90 patients were randomized, and 89 were analyzed (mean age 61.7 years, 31.5% women). At day 5, median e-NIHSS was 12.0 (IQR 3.5 to 30.0) in the minocycline group and 10.5 (IQR 2.0 to 35.0) in the control group; corresponding mean values were 15.0 (SD 13.5) and 17.2 (SD 16.9), respectively (adjusted mean difference\u2009\u2212\u20092.83 [95% CI -7.86 to 2.20];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.27). sICH within 24\u00a0h occurred in 2\/37 (5.4%) of participants in the minocycline group vs. 6\/41 (14.6%) in the control group (adjusted risk ratio, 0.70; 95% CI, 0.11 to 4.67). Other secondary efficacy and safety outcomes, including 90-day modified Rankin Scale, mortality, and adverse events, showed no significant differences between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Minocycline was well-tolerated in this population; however, these results did not provide evidence to support prescribing minocycline to improve early neurological outcomes. Larger trials of minocycline with extended treatment duration are warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>The trial was registered at ClinicalTrials.gov (NCT05512910) on August 23, 2022.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12916-026-05092-4","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T03:55:35Z","timestamp":1785124535000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Minocycline for acute basilar artery occlusion stroke undergoing endovascular treatment: a randomized, evaluator-blinded, open-label, pilot trial"],"prefix":"10.1186","volume":"24","author":[{"given":"Zhirong","family":"Fan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingjing","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiping","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiwang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangjun","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Jia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baiya","family":"Fan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingshun","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deshuai","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duolao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0612-2917","authenticated-orcid":false,"given":"Wen","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on the behalf of the MIST-B Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"5092_CR1","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1016\/S1474-4422(11)70229-0","volume":"10","author":"HP Mattle","year":"2011","unstructured":"Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G. 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