Acute Ischemic Stroke
Conditions
Keywords
Endovascular thrombectomy, Dexmedetomidine, Modified Rankin Scale
Brief summary
Dexmedetomidine can attenuate the activity of the sympathetic nervous system under stress response and improve ischemia-reperfusion injury. The investigators hypothesized that the prolonged sedation of dexmedetomidine after successful reperfusion of endovascular thrombectomy may improve the clinical outcome of acute ischemic stroke patients.
Detailed description
Endovascular treatment with mechanical thrombectomy is the standard treatment for acute large vessel occlusion. Dexmedetomidine is a commonly used sedative in endovascular thrombectomy of acute ischemic stroke. Dexmedetomidine can attenuate the activity of the sympathetic nervous system under stress response and improve ischemia-reperfusion injury. The investigators hypothesized that the prolonged sedation of dexmedetomidine after successful reperfusion of endovascular thrombectomy may improve the clinical outcome of acute ischemic stroke patients.
Interventions
DRUGDexmedetomidine prolonged sedation
Dexmedetomidine for 24h after patients finished endovascular thrombectomy and returned to ICU.
DRUG0.9% saline
An equal dose of 0.9% saline 24h after patients finished endovascular thrombectomy and returned to ICU.
Sponsors
Beijing Chao Yang Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* 2≤NIHSS≤25 * mRS score before stroke was less than 3 * Acute ischemic stroke (including anterior circulation) * mTICI rate 2b or 3 * According to the 2018 AHA/ASA guidelines for the management of acute ischemic stroke, patients who plan to receive mechanical thrombectomy under local anesthesia and sedation * Informed consent was signed by patient or legal representative
Exclusion criteria
* Intracerebral hemorrhage occurred in the responsible vessel area in the past 6 weeks * Patients who had received stent treatment at the responsible vessel in the past * Neurological function was restored at or before angiography * Patients who are allergic to heparin, aspirin, clopidogrel, rapamycin, lactic acid polymer, poly (n-butyl methacrylate), stainless steel, anesthetics and contrast agents or have contraindications * Hemoglobin was less than 70g/L, platelet count was less than 50×109/L, international normalized ratio (INR) greater than 1.5 (irreversible), there are uncorrectable bleeding factors * Blood glucose \< 2.7 mmol/L or \> 22.2 mmol/L * Severe liver or kidney disfunction, ALT\>3 times the upper limit of normal value or AST\>3 times the upper limit of normal value, creatinine\>1.5 times the upper limit of normal value * Pregnant or lactating women * Previous history of mental illness * Stroke with other acute diseases or postoperative stroke of other operation * Heart rate less than 50bpm, second or third degree of atrioventricular block (except for pacemaker implantation), systolic blood pressure less than 90mmHg (two vasoactive drugs were already infused continuously )
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The favorable functional outcome of stroke-related disability rate | 90 ± 14 days after thrombectomy | Modified Rankin Scale ≤ 2 points. mRS range from 0 to 6, higher scores mean a worse outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes of ischemic penumbra | on the 7-day or discharged day whichever comes first, up to 30 days | The difference of infarct volume between preoperative and 7-day or discharged day |
| Length of ICU stay | From the date of admission until discharged from ICU, up to 30 days | Length of ICU stay |
| Changes of National Institute of Health stroke scale | 24 ± 6 hours after thrombectomy | NIHSS (admission) - NIHSS (24h) |
| adverse events at 90-day after operation | within 90-day after thrombectomy | hypotension (systolic blood pressure under 90mmHg), bradycardia (heart rate under 50bpm), hypoxemia (pulse oxygen saturation under 90%), and serious events such as death and life-threatening events |
| mortality rate at 90-day after operation | within 90-day after thrombectomy | Death after thrombectomy within 90-day after operation |
| Length of hospital stay | From the date of admission until discharged from hospital, up to 30 days | Length of hospital stay |
Countries
China
Contacts
Primary ContactLina Yang
Outcome results
None listed