None listed
Conditions
Brief summary
Internationally stroke ranks fifth among all causes of death and is considered the second leading healthcare burden. Over the last 5 years endovascular thrombectomy (clot retrieval) has been effective for the treatment of acute large vessel ischaemic stroke, with significant reductions in long term patient disability compared to standard treatment. However, there is minimal definitive guidance on the importance of haemodynamic management during the procedure, which may be linked to poor functional recovery. The brain is especially vulnerable to BP variation during the acute stroke period due to ischaemia from the clot, reperfusion injury and impaired cerebral autoregulation. Theoretically, arterial hypertension may be detrimental as it leads to encephalopathy, cerebral oedema and haemorrhagic transformation of ischaemic tissue. Conversely, arterial hypotension may lead to hypoperfusion of the ischaemic brain and other organs. Current evidence is limited to large observational studies. Auckland DHB is one of 3 DHBs around New Zealand to provide a 24 hour thrombectomy service. This pilot study will examine the effect of two systolic blood pressures (SBP) management arms during clot retrieval on outcomes in patients with acute ischaemic stroke.
Interventions
Augmented - maintain SBP at 170mmHg +/-10mmHg from the onset of anaesthesia until recanalization. Maintenance of blood pressure is done at the discretion of the treating anaesthetist; according to New Zealand Society of Anaesthetists 2016 Guidelines
Sponsors
Dr Douglas Campbell
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Functionally independent patients (mRS 0 – 2) diagnosed with anterior circulation stroke (internal carotid artery or proximal M1 or M2 segment of middle cerebral artery) presenting within six hours of stroke onset who fulfil current guidelines for thrombectomy.
Exclusion criteria
Rescue’ procedures eg acute ischaemic stroke associated with major medical procedures such as coronary artery stenting and coronary artery bypass. • Prestroke mRS score of 3 (indicating previous disability) • Contraindication to imaging with contrast agents • Any terminal illness with expected survival less than 1 year • Pregnant women • Any medical condition where there is a contraindication to either treatment arm, or haemodynamic targeting will be problematic eg. severe aortic regurgitation
Outcome results
None listed