Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Mechanical thrombectomy is a very effective treatment in patients who have suffered an acute ischemic stroke associated with intracranial large vessel occlusion. However, less than half of the patients achieve functional independence despite treatment. The optimization of blood pressure after mechanical thrombectomy based on the degree of recanalization achieved at the end of the procedure could improve the perfusion of the ischemic brain tissue thanks to the improvement of blood circulation provided by collateral circulation. For this, authorized hypotensive or hypertensive drugs will be used. Moreover, this individualized treatment would allow to decrease reperfusion injury and therefore decrease the risk of intracerebral bleeding complications and cerebral edema. Therefore, we designed a clinical trial in which the standard management of blood pressure after mechanical thrombectomy will be compared with a specific protocol in which blood pressure targets are applied according to the degree of recanalization obtained during the thrombectomy procedure. The beneficial effect and risk reduction of this treatment will translate into a better short and long-term outcome
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard treatment | No Intervention | Post-thrombectomy patients will have their blood pressure measured every hour for the first 24 hours after thrombectomy, and every 6 hours from 24 to 72 hours. The target blood pressure is not predefined by the study, but in patients who have received previous treatment with rt-PA, it is advisable to keep it below 180/110 mmHg. If the patient has not received rt-PA, there is no limitation, although the guidelines recommend keeping the pressure below 200/120 mmHg. The hypotensive or hypertensive treatments used will be noted. | |
| Optimized hemodynamic treatment | Experimental | Post-thrombectomy patients will have their blood pressure measured every 30 minutes for the first 24 hours after thrombectomy, and every 1 hour from 24 to 72 hours. Blood pressure objectives will depend on the degree of recanalization achieved after thrombectomy (see intervention section). The hypotensive or hypertensive treatments used will be noted. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Adjusted medication | Other | In patients randomized to perfusion optimization, medication will be adjusted to maintain blood pressure according to the degree of recanalization:
Hypotensive drugs will be used when necessary. Intravenous labetalol is the treatment of choice, administered as a bolus or intravenous infusion. Alternative: urapidil (bolus or continuous infusion pump). If both drugs cannot be used or are insufficient, sodium nitroprusside can be used. Hypertensive drugs for TICI2b patients whose target pressure is 140-160mmHg and are below this range. Initially, a bolus of physiological saline or 100cc Plasmalyte® will be administered. If this treatment is not effective enough (blood pressure measurements persist <140 mmHg), intravenous phenylephrine will be administered. |
| Measure | Description | Time Frame |
|---|---|---|
| Modified Rankin scale value | State of functional independence, measured with the modified Rankin scale at 3 months (+/- 14 days). | 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| NIHSS score | 24 hours | |
| Mortality | Mortality from any cause at 3 months post-thrombectomy | 3 months |
Not provided
Inclusion Criteria:
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Joan Martí-Fàbregas, PhD, MD | Contact | 0034 93 5537636 | jmarti@santpau.cat | |
| Pol Camps-Renom, PhD, MD | Contact | 0034 935565986 | pcamps@santpau.cat |
Not provided
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital de la Santa Creu i Sant Pau | Recruiting | Barcelona | Spain |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42258192 | Derived | Camps-Renom P, Guasch-Jimenez M, Alvarez-Cienfuegos J, Lopez-Hernandez N, Rodriguez-Campello A, Tejada-Meza H, Lopez-Mesonero L, Albert-Lacal L, Freijo-Guerrero MM, Tarruella-Hernandez D, Flores A, Cabezas-Rodriguez JA, Fernandez-Vidal JM, Martinez-Domeno A, Perez de la Ossa N, Ramos-Pachon A, Aguilera-Simon A, Marin R, Ezcurra-Diaz G, Lambea-Gil A, Silva Y, Corona-Garcia DJ, Giralt-Steinhauer E, Marta-Moreno J, Vizcaya-Gaona JA, Sanz-Monllor A, Luna A, Lopez Morales M, Ustrell X, Moniche F, Sola-Roca J, Wang X, Anderson CS, Prats-Sanchez L, Marti-Fabregas J; HOPE Study Group. Personalized Blood Pressure Targeting After Endovascular Therapy for Acute Ischemic Stroke: A Randomized Clinical Trial. JAMA Neurol. 2026 Jun 8:e261706. doi: 10.1001/jamaneurol.2026.1706. Online ahead of print. | |
| 39208776 |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| ID | Term |
|---|---|
| D000083242 | Ischemic Stroke |
| ID | Term |
|---|---|
| D020521 | Stroke |
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
Not provided
Not provided
| ID | Term |
|---|---|
| D007741 | Labetalol |
| C015568 | urapidil |
| D010656 | Phenylephrine |
| D009599 | Nitroprusside |
| C048013 | Plasmalyte A |
| ID | Term |
|---|---|
| D004983 | Ethanolamines |
| D000605 | Amino Alcohols |
| D000438 | Alcohols |
| D009930 | Organic Chemicals |
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
|
|
| Intracranial hemorrhagic complication |
Rate of any intracranial hemorrhagic complication in the first 24 hours after the procedure. |
| 24 hours |
| Intracranial hemorrhagic complication | Rate of any intracranial hemorrhagic complication in the first 72 hours after the procedure. | 72 hours |
| Cerebral edema | Volume of cerebral edema at 24 hours in the post-thrombectomy CT scan. | 24 hours |
| Cerebral edema | Volume of cerebral edema at 72 hours in the post-thrombectomy CT scan. | 72 hours |
| Infarct size in the 24-hour post-thrombectomy CT. | Infarct size in the 24-hour post-thrombectomy CT. | 24 hours |
| Infarct size in the 72-hour post-thrombectomy CT. | Infarct size in the 72-hour post-thrombectomy CT. | 72 hours |
| Derived |
| Camps-Renom P, Guasch-Jimenez M, Martinez-Domeno A, Prats-Sanchez L, Ramos-Pachon A, Alvarez-Cienfuegos J, Silva Y, Fortea-Cabo G, Morales-Caba L, Rodriguez-Campello A, Giralt-Steinhauer E, Flores A, Ustrell X, Lopez-Hernandez N, Corona-Garcia DJ, Freijo-Guerrero MM, Luna A, Tejada-Meza H, Marta-Moreno J, Moniche F, Pardo-Galiana B, Castellanos M, Albert-Lacal L, Sanz-Monllor A, Aguilera-Simon A, Marin R, Ezcurra-Diaz G, Lambea-Gil A, Marti-Fabregas J. A Randomized Trial on Hemodynamic Optimization of Cerebral Perfusion after Successful Endovascular Therapy in Patients with Acute Ischemic Stroke (HOPE). Cerebrovasc Dis. 2025;54(4):559-566. doi: 10.1159/000540606. Epub 2024 Aug 29. |
| D009422 |
| Nervous System Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D012457 |
| Salicylamides |
| D000577 | Amides |
| D000588 | Amines |
| D005292 | Ferricyanides |
| D003486 | Cyanides |
| D000838 | Anions |
| D007477 | Ions |
| D004573 | Electrolytes |
| D007287 | Inorganic Chemicals |
| D005290 | Ferric Compounds |
| D058085 | Iron Compounds |
| D006856 | Hydrogen Cyanide |
| D017672 | Nitrogen Compounds |