Transcranial direct current stimulation is safe and feasible in hyperacute ischemic stroke (DICAST-SF trial)

Cathodal transcranial direct current stimulation (C-tDCS) is emerging as a potential neuroprotective intervention during the hyperacute phase of ischemic stroke. The DICAST-SF trial was conducted to systematically assess the safety, tolerability, feasibility, and potential efficacy of this treatment in patients presenting with a salvageable penumbra. Study Design and Inclusion: DICAST-SF was a double-blind, randomized, sham-controlled (3 active : 1 sham), 3 + 3 dose-escalation trial. Participants: 25 patients were enrolled (19 active, 6 sham) with a mean age of 81 years and a median NIHSS score of 8., Criteria: Inclusion required stroke due to occlusion of the internal carotid or middle cerebral artery, last known well time within 24 hours, substantial penumbra on CT perfusion, and ineligibility for mechanical thrombectomy., Intervention: C-tDCS was applied at six dose tiers directly over the affected primary motor cortex. Key Findings & Safety Outcomes:. Safety: The primary safety outcome was achieved, with no symptomatic intracranial hemorrhage (SICH) occurring at 24 hours post-stimulation. Rates of early neurological deterioration, serious adverse events, and 90-day mortality were comparable between the active and sham arms., Feasibility: The intervention proved highly feasible in an acute clinical setting. The median randomization-to-C-tDCS start time was just 8 minutes (IQR 7–9), well within the targeted 10-minute threshold., Tolerability: Completion rates and questionnaire data indicated that the C-tDCS application was very well tolerated by the patient cohort. Clinical Interpretation: The application of C-tDCS in the hyperacute phase of ischemic stroke is safe, well-tolerated, and logistically feasible. These positive indicators strongly support the advancement of this neuroprotective methodology into larger-scale efficacy trials.