Cerebral Autoregulation Guiding Blood Pressure Management After Revascularization

Cerebral Hemodynamic Management Based on Cerebral Autoregulation Monitoring in Acute Ischemic Stroke Patients After Endovascular Treatment: a Multicenter, Open-label, Randomized Control Study

This clinical trial aims to learn whether blood pressure (BP) guided by individualized cerebral autoregulation (CA) is safe and provides a better prognosis than a fixed target in patients with ischemic stroke after endovascular therapy. The BP of participants will be managed at least 48 hours after revascularization. Researchers will compare the CA-guided BP group with the fixed target BP group to mainly see if individualized BP could help more patients to have their neurological function improved at seven days.

Inclusion Criteria:

• Acute ischemic stroke, undergone endovascular treatment within 24 hours of onset (time of stroke is the last known normal for wake-up stroke or with unknown onset time), with reaching the goal of mTICI grade 2b-3
• No functional disability before stroke (mRS 0-1)
• Angiography (CTA, MRA or DSA) before endovascular therapy confirmed occlusion of the internal carotid artery and/or the middle cerebral artery M1 to M2 segment, with consistent clinical symptoms.
• Informed consent is given by the patient or the legal representative.

Exclusion Criteria:

• Hemorrhagic transformation with mass effect (PH-2 type parenchymal hematoma) occurs during the operation.
• Coma, dilated pupils on one or both sides, dull or absent light reflex is noticed before randomization
• Dissection of aorta, common carotid artery, internal carotid artery, subclavian artery, intracranial artery; severe bilateral subclavian artery stenosis; contraindications of radial artery puncture were found before or during surgery.
• Shock.
• Severe cardiomyopathy with heart failure (EGFR ≤ 30% or NYHA Grade IV), acute myocardial infarction, or unstable angina.
• Possible infective endocarditis, infective embolism, or vasculitis.
• Participating in other clinical research involving drug or device intervention after endovascular therapy.
• Women who plan or are pregnant, or breastfeeding.
• Severe liver or kidney disease, malignant tumor with a life expectancy is less than 3 months.
• The 90-day follow-up is not expected to be completed.