Effect of Postoperative Prolonged Sedation With Dexmedetomidine After Successful Reperfusion With EVT on Long-term Prognosis in Patients With AIS (PPDET)
- Conditions
- Acute Ischemic Stroke
- Interventions
- Drug: 0.9% saline
- Registration Number
- NCT04916197
- Lead Sponsor
- Beijing Chao Yang Hospital
- 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.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 368
- 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
- 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 )
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention group Dexmedetomidine prolonged sedation Dexmedetomidine 0.1\~1.0 μg/kg/h for 24h after patients finished endovascular thrombectomy and returned to ICU. Maintain Ramsay score 2-3. Control group 0.9% saline An equal dose of saline 24h after patients finished endovascular thrombectomy and returned to ICU. If the Ramsay sedation score is 1, propofol will be administrated to maintain the Ramsay sedation score at 2 to 3.
- Primary Outcome Measures
Name Time Method 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 Outcome Measures
Name Time Method 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
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 on the 7-day or discharged day whichever comes first, up to 30 days NIHSS (admission) - NIHSS (7day)
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 hospital stay From the date of admission until discharged from hospital, up to 30 days Length of hospital stay
mortality rate at 90-day after operation within 90-day after thrombectomy Death after thrombectomy within 90-day after operation
Trial Locations
- Locations (1)
Beijing ChaoYang Hospital
🇨🇳Beijing, Beijing, China