Ischemic stroke happens when a blood clot blocks flow to part of the brain, killing brain cells within minutes. It's the most common type of stroke, affecting nearly 700,000 Americans yearly. Treatment focuses on removing the clot quickly and preventing future strokes with blood thinners, blood pressure drugs, and sometimes surgery.
What's actually going on in research
Trials are testing clot-removing drugs that work beyond the current time window, neuroprotective drugs that keep brain cells alive during and after stroke, treatments that help the brain rewire itself during recovery, and new approaches to prevent strokes in people with atrial fibrillation or carotid artery disease.
Extended treatment windows
New imaging can identify people who might still benefit from clot removal 16 or even 24 hours after stroke began. Trials are testing whether drugs and devices work safely in this longer window.
Neuroprotection
Researchers are testing drugs that protect brain cells from dying when blood flow is cut off. The goal is to preserve more brain tissue even when clot removal is delayed.
Recovery enhancement
Studies are testing drugs, brain stimulation, and rehab approaches that help the brain form new connections after stroke. Some trials combine therapy with medications that enhance neuroplasticity.
What to know before you search
Eligibility typically depends on time since stroke began, stroke severity, brain imaging findings, medical history including bleeding risk, and current medications.
What types of trials are currently open
- Acute treatment trials — Testing new clot-dissolving drugs or mechanical devices to remove clots, often comparing them to the current standard of tPA and thrombectomy.
- Prevention trials — Testing anticoagulants, antiplatelet drugs, and blood pressure medications to prevent a second stroke in people who've already had one.
- Neuroprotection trials — Testing drugs given during or just after stroke that aim to reduce brain damage and improve outcomes.
- Recovery trials — Testing rehabilitation approaches, brain stimulation, or drugs that enhance recovery of movement, speech, or cognition after stroke.
- Imaging studies — Using advanced brain scans to identify which patients might benefit from treatment hours after symptom onset.
Recently added Ischemic Stroke trials
A Standard Carbon Dioxide Flushing Protocol to Reduce Air Embolization During Thoracic Endovascular Aortic Repair
FlushTEVAR is a non-profit, interventional, randomized, controlled, single-blind, national multicenter study promoted by the University of Bologna and coordinated by the Vascular Surgery Unit of IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, under the direction of Prof. Mauro Gargiulo, who also serves as Principal Investigator. The study aims to develop and evaluate a pre-implant thoracic endograft flushing technique using carbon dioxide (CO₂) to reduce periprocedural embolic events and cerebral infarctions in patients undergoing Thoracic Endovascular Aortic Repair (TEVAR). TEVAR is currently the treatment of choice for acute aortic syndromes and aneurysms involving the descending thoracic aorta. Despite its widespread use, TEVAR remains associated with significant neurological complications, with an incidence ranging from 3% to 8% in standard procedures and reaching up to 16% in more complex endovascular interventions. Cerebral embolization caused by solid and gaseous particles is considered the main cause of perioperative stroke and silent brain infarction (SBI), the latter being defined as ischemic brain injury detected by neuroradiological imaging in the absence of immediate clinical symptoms. During TEVAR, approximately 90% of microembolic signals detected in the middle cerebral artery are caused by gaseous emboli, with the highest number occurring during endograft deployment. This phenomenon is associated with the manufacturing and sterilization processes of endografts, during which gas microparticles become trapped between the endograft and its delivery system and are subsequently released into the bloodstream when the device is deployed at the intended aortic site. The primary objective of the study is to assess the difference in the incidence of major neurological events, including stroke and transient ischemic attack (TIA), as well as silent brain infarctions, between patients whose endografts undergo a standardized pre-implant flushing protocol with CO₂ followed by conventional saline flushing, and patients receiving standard saline flushing alone. Major neurological events will be assessed clinically, while silent brain infarctions will be evaluated using study-specific diffusion-weighted magnetic resonance imaging (DW-MRI) of the brain performed within 72 hours after the procedure. A total of 90 patients will be enrolled across four participating centers and randomized in a 1:1 ratio after providing informed consent. Forty-five patients will be allocated to the experimental arm and treated with CO₂ flushing before the standard saline flushing procedure during TEVAR, while forty-five patients will be allocated to the control arm and will receive standard saline flushing only. Eligible patients must be at least 18 years of age and present with type B acute aortic syndrome in the acute, subacute, or chronic phase, or thoracic and thoracoabdominal aneurysms with Crawford extent I, II, III, or IV. Written informed consent is required for participation. Patients will be excluded if the procedure is performed using CO₂ angiography, if endografts without a sheath are used, if emergency endovascular treatment is required, if they have experienced a stroke or TIA within the previous six months, if the proximal sealing zone is 0 or 1, if any contraindication to DW-MRI is present, or in cases of pregnancy or breastfeeding. At study completion, the two treatment groups will be compared on the basis of diffusion-weighted brain MRI findings. The primary endpoint is the number of silent brain infarctions and the determination of whether a statistically significant difference exists between the CO₂ flushing group and the saline flushing group. The safety of the procedure will be evaluated through both technical and clinical success. The planned study duration is three years, and postoperative rates of SBI and TIA/stroke will be compared between groups using Fisher's and Pearson's chi-square tests.
MSC Secretome Therapy for Cognitive Recovery After Subacute Ischemic Stroke
Post-stroke cognitive impairment can limit rehabilitation, independence, and quality of life after ischemic stroke. This pilot randomized controlled trial evaluates whether mesenchymal stem cell-derived secretome, given in addition to standard stroke care and rehabilitation, improves cognitive recovery in patients with subacute ischemic stroke. Participants aged 40 to 75 years with ischemic stroke occurring 7 days to 3 months previously and mild-to-moderate cognitive impairment will be randomly assigned in a 1:1 ratio to receive standard care and rehabilitation plus MSC secretome or standard care and rehabilitation without MSC secretome. The primary outcome is the change in the Indonesian version of the Montreal Cognitive Assessment score. Secondary outcomes include quantitative electroencephalography parameters, serum brain-derived neurotrophic factor, serum interleukin-1β, NIHSS, modified Rankin Scale, and adverse events.
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