Prognostic Biomarkers for Selective Intra-Arterial Cooling Infusion Combined with Endovascular Thrombectomy in Acute Ischemic Stroke Based on Proteomics and Metabolomics.

NCT ID: NCT06665386

Last Updated: 2024-12-12

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

Total Enrollment

258 participants

Study Classification

OBSERVATIONAL

Study Start Date

2024-10-27

Study Completion Date

2025-02-28

Brief Summary

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Endovascular Thrombectomy has emerged as a pivotal treatment modality for acute ischemic stroke. However, despite successful thrombus removal, a substantial proportion of patients still experience poor outcomes. Selective intra-arterial cooling has shown promise in decelerating stroke progression and providing neuroprotection. This study aims to identify biomarkers associated with the combination of selective intra-arterial cooling infusion and endovascular thrombectomy in the treatment of ischemic stroke by integrating proteomics and metabolomics data. Our study is based on the multicenter RCT study "Safety and Efficacy of Selective Intra-Arterial Cooling Infusion Combined With EVT in Acute Ischemic Stroke." All samples were derived from this experiment. Our objective is to elucidate the molecular mechanisms underlying the prognostic impact of this combined therapeutic approach, providing insights to optimize stroke treatment strategies.

Detailed Description

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Conditions

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Stroke Hypothermia Treatment

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Control Group

Patients will receive best medical management (BMM) plus EVT according to the clinical guidelines.

No interventions assigned to this group

IA-SCI group

Patients will receive BMM and EVT combined with selective intra-arterial cold saline infusion.

hypothermia

Intervention Type PROCEDURE

Patients who meet the inclusion criteria and do not meet the exclusion criteria will be randomly assigned to either the control group or the IA-SCI group. Control group patients will receive BMM and EVT. IA-SCI group patients will receive BMM and EVT, and additionally a selective intraarterial cooling infusion. The specific method is as follows:

* Pre-recanalization: During the procedure, a micro-catheter used to deploy the stent retriever is threaded coaxially into the common femoral artery through the guide catheter. The microcatheter is advanced over a microguide wire, traveling up through the neck until it reaches beyond the clot. A 50 mL cold 0.9% saline (4℃) is infused into the ischemic territory at a rate of 10 mL/min via the microcatheter. This enables the cold solution to infuse into the ischemic territory prior to revascularization.
* Post-recanalization: Following vessel recanalization, cold 0.9% saline (4 ℃) is reinfused into the vessel via the catheter at a rate of 22 mL

Interventions

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hypothermia

Patients who meet the inclusion criteria and do not meet the exclusion criteria will be randomly assigned to either the control group or the IA-SCI group. Control group patients will receive BMM and EVT. IA-SCI group patients will receive BMM and EVT, and additionally a selective intraarterial cooling infusion. The specific method is as follows:

* Pre-recanalization: During the procedure, a micro-catheter used to deploy the stent retriever is threaded coaxially into the common femoral artery through the guide catheter. The microcatheter is advanced over a microguide wire, traveling up through the neck until it reaches beyond the clot. A 50 mL cold 0.9% saline (4℃) is infused into the ischemic territory at a rate of 10 mL/min via the microcatheter. This enables the cold solution to infuse into the ischemic territory prior to revascularization.
* Post-recanalization: Following vessel recanalization, cold 0.9% saline (4 ℃) is reinfused into the vessel via the catheter at a rate of 22 mL

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age ≥18 and ≤80.
* Clinical signs consistent with acute ischemic stroke with large vessel occlusion in the anterior circulation (intracranial segment of the internal carotid artery, middle cerebral artery M1 segment) demonstrated with CTA/MRA/DSA.
* NIHSS score obtained prior to randomization ≥6 and ≤25.
* Modified Rankin Scale ≤ 1 prior to qualifying stroke.
* Arterial puncture performed within 24 hours from symptom onset or LKW.
* For the patients with symptom onset within 6 hours, the ASPECT score ≥6; for the patientswith onset within 6-24 hours, the therapy should meet the imaging criteria of DAWN or DEFUSE-3 trial.
* Patient/Legally Authorized Representative has signed the Informed Consent Form.

Exclusion Criteria

* Baseline CT/MRI confirms the presence of multiple vascular territory acute strokes.
* Baseline CT/MRI confirms the presence of arterial dissection.
* Evidence of intracranial hemorrhage or hemorrhagic transformation before thrombectomy.
* Known allergies or intolerances to antiplatelet agents, anticoagulation drugs, iodinated contrast and/or anesthetics.
* Severe infection (e.g. sepsis) or multiple organ failure.
* Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency; recent oral anticoagulant therapy with INR \> 3. Patients on factor Xa inhibitor for 48 hours ago must have a normal APTT.
* Baseline platelet count \<50 × 109/L.
* Blood glucose concentration\<50 mg/dL (2.7mmol/L) or \>400 mg/dL (22.2mmol/L).
* Refractory hypertension that is difficult to control by medication (Defined as persistent systolic blood pressure\>185 mmHg or diastolic blood pressure\>110mmHg).
* Previous NHYA\>1.
* Untreated moderate or severe coronary artery stenosis, or previous coronary artery bypass surgery.
* Undergoing hemodialysis or peritoneal dialysis; known severe renal insufficiency with glomerular filtration rate \<30 ml/min or serum creatinine \>220 mmol/L (2.5mg/dl).
* Known intracranial aneurysm, and cerebral arteriovenous malformation.
* Malignant brain tumor or CNS infection.
* Pre-existing neurological or psychiatric disease that would confound the neurological or functional evaluations (e.g., dementia or mental illness)
* Female who is pregnant or lactating at time of admission.
* Anticipated life expectancy \<6 months.
* Current participation in another investigational drug or device study.
* For other reasons, the responsible clinicians believe that the patient is not suitable for continued treatment.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Capital Medical University

OTHER

Sponsor Role lead

Responsible Party

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Ji Xunming,MD,PhD

MD.PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Dalian Municipal Central Hospital

Dalian, Liaoning, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Xunming Ji, Professor

Role: CONTACT

Phone: +86 17600104266

Email: [email protected]

Facility Contacts

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Di Li

Role: primary

Other Identifiers

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PBIA

Identifier Type: -

Identifier Source: org_study_id