Transcranial Direct Current Stimulation as a Neuroprotection in Acute Stroke Before and After Thrombectomy
This proposal is a prospective, single-center, dose-escalation safety, tolerability, feasibility and potential efficacy study of transcranial direct current stimulation (tDCS) in acute stroke patients with substantial salvageable penumbra due to a large vessel occlusion before and after endovascular therapy.
- New focal neurologic deficit consistent with AIS
- NIHSS ≥ 4
- ICA or M1 or M2 MCA occlusion on pre-thrombectomy MRA or CTA
- Onset (last-seen-well) time to randomization time within 24 hours
- Pre-stroke modified Rankin Scale≤ 3.
- Patient ineligible for IV tPA, per national AHA/ASA Guidelines.
- Having undergone endovascular thrombectomy with less than a complete reperfusion (<TICI 2c, 3) for receiving post-thrombectomy adjunct C-tDCS.
- Undergoing endovascular thrombectomy, per national AHA/ASA Guidelines for patients who are assigned to pre-thrombectomy bridging session at Tiers 5, 6.
- A signed informed consent is obtained from the patient or patient's legally authorized representative
- Acute intracranial hemorrhage
- Evidence of a large Ischemic core volume (ADC < 620 µm2/s or rCBF< 30%) ≥ 100 ml
- Presence of tDCS contraindications - electrically or magnetically activated intracranial metal and non-metal implants.
- Severe contrast allergy or absolute contraindication to iodinated contrast preventing endovascular intervention.
- History of seizure disorder or new seizures with presentation of current stroke
- Evidence of any other major life-threatening or serious medical condition that would prevent completion of the study protocol including attendance at the 3-month follow-up visit
- Concomitant experimental therapy
- Preexisting scalp lesion at the site of the stimulation or presence of skull defects (may alter current flow pattern)
- Preexisting coagulopathy, consist of a platelet count of ≤ 100, INR ≥ 3, PTT ≥ 90.