Comparison of Perioperative Conscious Sedation During Endovascular Thrombectomy in Acute Ischemic Stroke

NCT ID: NCT06139692

Last Updated: 2025-11-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

810 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-11-21

Study Completion Date

2026-06-13

Brief Summary

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This study aims to conduct a multicenter, prospective, randomized clinical trial to scientifically evaluate the safety and efficacy of different perioperative sedation methods during endovascular thrombectomy in acute ischemic stroke patients with large vessel occlusion in the anterior circulation.

Detailed Description

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In the perioperative period of endovascular thrombectomy, the main sedation options are midazolam (MDZ) and dexmedetomidine (DEX). Research has shown that both sedation methods have their advantages and disadvantages, and there is no consensus on how to choose between them. Therefore, this study aims to conduct a multicenter, prospective, randomized clinical trial to scientifically evaluate the safety and efficacy of different perioperative sedation methods during endovascular thrombectomy (EVT) in AIS patients with large vessel occlusion in the anterior circulation and hopes to contribute to the advancement of EVT in clinical practice.

In this trial, acute ischemic stroke patients with large vessel occlusion in the anterior circulation within 24 hours of symptom onset or last known well will be included. In the screening stage, participants who meet the inclusion criteria of the trial, upon completion of screening/baseline assessment and after signing the informed consent, will be randomly assigned in a 1:1 ratio to one of the following two treatment groups: the dexmedetomidine and midazolam conscious sedation groups. The primary end point is the proportion of modified Ranking score of 0-2 at 90 days.

Conditions

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Acute Ischemic Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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the dexmedetomidine group

In the experimental group, dexmedetomidine is used for intraoperative sedation. Dexmedetomidine is prepared as an 8μg/ml intravenous infusion. It begins with an initial loading dose of 1μg/kg, administered over a period exceeding 10 minutes.If dexmedetomidine fails to achieve a satisfactory level of sedation during surgery, physicians may opt for rescue sedation with propofol or consider transferring the patient to general anesthesia. Propofol (20ml 0.2g) starts with a loading dose of 0.3mg/(kg\*h) and a maintenance dose of 0.3-4mg/(kg\*h). The infusion rate can be adjusted based on the sedation effect to achieve the appropriate level of sedation during EVT.

Group Type EXPERIMENTAL

Dexmedetomidine

Intervention Type DRUG

Patients receive perioperative sedation with dexmedetomidine

the midazolam group

In the control group, midazolam is used for intraoperative sedation. Midazolam is prepared as a 1mg/ml intravenous infusion. It starts with an initial intravenous push of 0.05mg/kg, followed by a maintenance dose of 0.04-0.2mg/kg administered intravenously via an infusion pump. If midazolam fails to achieve a satisfactory level of sedation during surgery, physicians may opt for rescue sedation with propofol or consider transferring the patient to general anesthesia. Propofol (20ml 0.2g) starts with a loading dose of 0.3mg/(kg\*h) and a maintenance dose of 0.3-4mg/(kg\*h). The infusion rate can be adjusted based on the sedation effect to achieve the appropriate level of sedation during EVT.

Group Type ACTIVE_COMPARATOR

Midazolam

Intervention Type DRUG

Patients receive perioperative sedation with midazolam

Interventions

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Dexmedetomidine

Patients receive perioperative sedation with dexmedetomidine

Intervention Type DRUG

Midazolam

Patients receive perioperative sedation with midazolam

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Age ≥18 years
2. Presenting with symptoms of acute ischemic stroke
3. CTA or MRA confirmed occlusion of the anterior circulation (intracranial carotid artery or M1, M2 segment of the middle cerebral artery)
4. Randomization finished within 24 hours of symptom onset or time last know well
5. Pre-stroke mRS score ≤2
6. NIHSS score ≥6 at the time of randomization
7. ASPECTS value ≥3
8. Informed consent signed

Exclusion Criteria

1. Pregnant or lactating women
2. Known allergy to contrast agents or nitinol devices
3. Known allergy to midazolam or other benzodiazepines
4. Known allergy to dexmedetomidine or its components
5. Planned to receive general anesthesia for EVT
6. Uncontrolled hypertension or hypotension (defined as systolic blood pressure \>185 mmHg or \< 90 mmHg, diastolic blood pressure \>110 mmHg or \< 60 mmHg)
7. Second-degree or third-degree heart blockage or bradyarrhythmia with a baseline heart rate lower than 50 beats/min
8. Any major surgery or serious trauma within 14 days
9. Known genetic or acquired bleeding diathesis (platelet count \< 100\\\*109 /L, activated partial thromboplastin time \> 50 s or international normalized ratio \> 1.7)
10. Blood glucose \<2.8 or \> 22.2 mmol/L
11. Severe renal insufficiency (defined as glomerular filtration rate \<30 ml/min or serum creatinine \>220 mmol/L (2.5mg/dl))
12. Receiving hemodialysis or peritoneal dialysis
13. Life expectancy less than 1 year
14. Severe agitation or seizures
15. Clinical manifestations of central nervous system vasculitis
16. Premorbid neurological disease or mental disorders confounding evaluation
17. Unwilling to be followed up within 90 days

1\. Evidence of intracranial hemorrhage on CT or MRI 2. Cerebellar infarction with obvious space-occupying effects and fourth ventricle compression on CT or MRI 3. Any untreated or incompletely treated intracranial aneurysm or any intracranial vascular malformation 4. Bilateral occlusion or multiple intracranial vessels occlusions 5. Intracranial tumors (with mass effect)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Jinling Hospital, China

OTHER

Sponsor Role lead

Responsible Party

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Xinfeng Liu

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Xinfeng Liu

Role: PRINCIPAL_INVESTIGATOR

Department of Neurology, Jinling Hospital, China

Locations

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Jinling Hospital, Medical School of Nanjing University

Nanjing, None Selected, China

Site Status RECRUITING

The General Hospital of Western Theater Command PLA

Chengdu, , China

Site Status RECRUITING

Countries

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China

Central Contacts

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Rui Liu

Role: CONTACT

+86 2584801861

Xinfeng Liu

Role: CONTACT

+86 2584801861

Facility Contacts

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Rui Liu

Role: primary

+862584801861

Xinfeng Liu

Role: backup

+862584801861

Yao Huang

Role: primary

+86-18608398843

Other Identifiers

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PEACE

Identifier Type: -

Identifier Source: org_study_id

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