Acute Ischemic Stroke, Large Vessel Occlusion
Conditions
Keywords
Mechanical Thrombectomy, Anterior Circulation Large Vessel Occlusion, Trans-Thrombus Gradient, Inflammatory Biomarkers, Reperfusion Injury, Modified Rankin Scale, Interleukin-6
Brief summary
The goal of this observational study is to describe the local change in interleukin-6 (IL-6) across a blood clot in adults with acute ischemic stroke caused by anterior circulation large vessel occlusion who are undergoing mechanical thrombectomy. The main questions it aims to answer are: * Is the level of IL-6 different in arterial blood collected beyond the clot compared with arterial blood collected before the clot during mechanical thrombectomy? * Is the trans-thrombus IL-6 difference associated with functional independence 90 days after stroke and with complications related to reperfusion injury? There is no comparison group and no experimental treatment. Researchers will compare paired blood samples collected from opposite sides of the clot in the same participant. Blood collected from a peripheral vein at hospital admission will be used only as a supportive reference for systemic inflammation. Participants will: * Receive standard mechanical thrombectomy and stroke care determined by their treating clinical team. * Have small blood samples collected at planned time points, including paired arterial blood samples collected during the thrombectomy procedure. * Have clinical and imaging information collected from their medical records and have functional status assessed 90 days after stroke. The study will not delay or change standard stroke treatment.
Interventions
OTHERProspective Mechanical Thrombectomy Cohort
Adults with acute ischemic stroke due to anterior circulation large vessel occlusion who undergo clinically indicated mechanical thrombectomy. All participants receive standard stroke care determined by the treating clinical team; no experimental intervention is assigned. Paired arterial blood samples are collected during thrombectomy from sites proximal and distal to the thrombus. A peripheral venous blood sample collected at hospital admission is used as a supportive systemic reference. Clinical, imaging, procedural, and 90-day functional outcome data are collected prospectively.
Sponsors
Zhongshan Hospital Xiamen University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 years or older. * Acute ischemic stroke caused by anterior circulation large vessel occlusion, confirmed by routine vascular imaging or digital subtraction angiography. * Undergoing clinically indicated mechanical thrombectomy according to routine clinical practice. * Provision of written informed consent by the participant or legally authorized representative, in accordance with local ethics requirements.
Exclusion criteria
* Posterior circulation large vessel occlusion. * Mechanical thrombectomy not performed. * Known active systemic infection, active malignancy, or chronic inflammatory/autoimmune disease requiring systemic immunosuppressive treatment, when these conditions are expected to substantially affect inflammatory biomarker measurements. * Pregnancy or breastfeeding, if required by the local ethics committee. * Enrollment in another interventional study that could affect inflammatory biomarker measurements or clinical outcome assessment. * Inability to obtain informed consent, where consent from a legally authorized representative is not permitted or cannot be obtained.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Trans-Thrombus Interleukin-6 Gradient | During mechanical thrombectomy, before recanalization | The primary outcome is the within-participant trans-thrombus interleukin-6 (IL-6) gradient, defined as ln \[T2b/T2a\], where T2b is the IL-6 concentration in arterial plasma collected distal to the thrombus and T2a is the IL-6 concentration in arterial plasma collected proximal to the thrombus. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Trans-Thrombus Interleukin-1 Beta Gradient | During mechanical thrombectomy, before recanalization | The primary outcome is the within-participant trans-thrombus Interleukin-1β gradient, defined as ln\[T2b/T2a\], where T2b is the Interleukin-1β concentration in arterial plasma collected distal to the thrombus and T2a is the Interleukin-1β concentration in arterial plasma collected proximal to the thrombus. |
| Trans-Thrombus Interleukin-17 Gradient | During mechanical thrombectomy, before recanalization | The primary outcome is the within-participant trans-thrombus Interleukin-17 gradient, defined as ln\[T2b/T2a\], where T2b is the Interleukin-17 concentration in arterial plasma collected distal to the thrombus and T2a is the Interleukin-17 concentration in arterial plasma collected proximal to the thrombus. |
| Trans-Thrombus Complement C3 Gradient | During mechanical thrombectomy, before recanalization | The primary outcome is the within-participant trans-thrombus Complement C3 gradient, defined as ln\[T2b/T2a\], where T2b is the Complement C3 concentration in arterial plasma collected distal to the thrombus and T2a is the Complement C3 concentration in arterial plasma collected proximal to the thrombus. |
| Trans-Thrombus Complement C5a Gradient | During mechanical thrombectomy, before recanalization | The primary outcome is the within-participant trans-thrombus Complement C5a gradient, defined as ln\[T2b/T2a\], where T2b is the Complement C5a concentration in arterial plasma collected distal to the thrombus and T2a is the Complement C5a concentration in arterial plasma collected proximal to the thrombus. |
| Trans-Thrombus Malondialdehyde Gradient | During mechanical thrombectomy, before recanalization | The primary outcome is the within-participant trans-thrombus Malondialdehyde gradient, defined as ln\[T2b/T2a\], where T2b is the Malondialdehyde concentration in arterial plasma collected distal to the thrombus and T2a is the Malondialdehyde concentration in arterial plasma collected proximal to the thrombus. |
| Trans-Thrombus Matrix Metalloproteinase-9 Gradient | During mechanical thrombectomy, before recanalization | The primary outcome is the within-participant trans-thrombus Matrix Metalloproteinase-9 gradient, defined as ln\[T2b/T2a\], where T2b is the Matrix Metalloproteinase-9 concentration in arterial plasma collected distal to the thrombus and T2a is the Matrix Metalloproteinase-9 concentration in arterial plasma collected proximal to the thrombus. |
| Modified Rankin Score | 90 (±14) days | The ordinal distribution of modified Rankin Scale (mRS) scores from 0 (no symptoms) to 6 (death). |
| Functional independence | 90 (±14) days | The proportion of mRS score of 0-2 at 90 days. |
| Good Function | 90 (±14) days | The proportion of mRS score of 0-3 at 90 days. |
| Early neurological improvement | 24 (±12) hours | The proportion of NIHSS 0-1 or ≥4 points reduction at 24 (±12) hours. |
| Change in stroke severity | 7 (±1) days or at discharge | The change of NIHSS score from baseline to 7 days or at discharge (whichever comes first) |
| Quality of life measured by EQ-5D-5L | 90 (±14) days | EQ-5D-5L scale score at 90 days. |
Countries
China
Contacts
CONTACTXingyu Chen, MD
CONTACTYibin Xiao, MD
PRINCIPAL_INVESTIGATORXingyu Chen, MD
Zhongshan Hospital Xiamen University
Outcome results
None listed