Minocycline After Successful Endovascular Thrombectomy Recanalization in Acute Anterior Circulation Large Vessel Occlusion (ATTRACTION-MINOA)

Inclusion Criteria: 1. Age ≥18 years; 2. Pre-stroke mRS score of 0-1; 3. Time from symptom onset to randomization ≤24 hours, including wake-up stroke or unwitnessed stroke. Symptom onset is defined as the last known well time; 4. Baseline NIHSS score of 6-25; 5. ASPECTS ≥6 on non-contrast CT or DWI; 6. Clinical symptoms attributable to acute occlusion at one of the following sites, confirmed by CTA, MRA, or DSA: intracranial internal carotid artery, M1 segment of the middle cerebral artery, or M2 trunk of the MCA; 7. Successful recanalization defined as mTICI 2b-3 after mechanical thrombectomy, with no evidence of secondary embolization in non-target vessels; or spontaneous improvement to mTICI 2b-3 on diagnostic angiography prior to thrombectomy with no planned intervention; 8. Ability of the patient or legally authorized representative to provide written informed consent. Exclusion Criteria: 1. Acute intracranial hemorrhage on CT or MRI; 2. Bilateral acute stroke or multiple intracranial large vessel occlusions; 3. Isolated extracranial internal carotid artery occlusion; 4. History of pseudomembranous colitis or antibiotic-associated colitis; 5. Known allergy to tetracycline antibiotics, any component of the investigational drug, radiocontrast agents, or nitinol materials; 6. Known resistance to tetracycline antibiotics; 7. Use of tetracycline antibiotics within 7 days prior to randomization; 8. History of intracranial hemorrhage within the past 3 months, including intraparenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage, subdural hematoma, or epidural hematoma; 9. Intracranial tumors, vascular malformations, or other space-occupying intracranial lesions; 10. History of intracranial or spinal surgery within the past 3 months; 11. History of major surgery or significant trauma within the past 1 month; 12. Receipt of any of the following treatments within the past 3 months: systemic retinoic acid or androgen/antiandrogen therapy (e.g., anabolic steroids, spironolactone); 13. Platelet count \<100 × 10⁹/L; 14. Severe hepatic insufficiency, chronic hemodialysis, or severe renal insufficiency (defined as estimated glomerular filtration rate \<30 mL/min or serum creatinine \>265.2 μmol/L \[3.0 mg/dL\]); 15. Women who are pregnant or lactating, or who have a positive pregnancy test prior to randomization; 16. Life expectancy \<6 months (e.g., due to malignancy or severe cardiopulmonary disease); 17. Participation in another interventional clinical trial that may affect outcome assessment; 18. Any other condition that, in the investigator's judgment, makes the patient unsuitable for participation or poses significant risk (e.g., inability to understand or comply with study procedures or follow-up due to psychiatric, cognitive, or emotional disorders).