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This observational study was designed for observe the cerebral hemodynamics and dynamic cerebral autoregulation (dCA) after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) patients. And analysis the relationship between the dCA damage degree and hemorrhage transformation (HT) and clinical outcome.
Patients: patients with AIS caused by middle cerebral artery or internal carotid artery occlusion who accepted EVT.
dCA Examination: dCA examinations were performed at 24 hours, 48 hours, 72 hours, and 5 days after EVT.
The objectives of the study were as follows: The changes of cerebral hemodynamics and parameters of dCA in different time periods after EVT were analyzed. So as to determine the correlation between hemodynamics and dCA change and HT and clinical outcome after EVT and to explore the predictors of HT and adverse clinical outcomes.
Part of the data from March 2022 to March 2022 was obtained, but it was still need more data and need a one-year follow-up of the data. Therefore, this is a 4 years prospective cohort study.
The objectives of the study were as follows: This observational study was designed for observe the cerebral hemodynamics and dynamic cerebral autoregulation (dCA) after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) patients. And analysis the relationship between the dCA damage degree and hemorrhage transformation (HT) and clinical outcomes. To explore the predictors of HT and adverse clinical outcomes.
A. To enroll 300 cases of patients with AIS caused by middle cerebral artery or internal carotid artery occlusion who accepted EVT.
B. dCA examinations were performed at 24 hours, 48 hours, 72 hours, and 5 days after EVT.
C. The computed tomography was performed to distinguish if the patients have HT within 7 days after EVT.
D. Utilizing the modified Rankin Scale (mRS), the clinical prognosis was assessed 3 months and 1 year after stroke. The outcomes were dichotomized according to the mRS score: favorable outcome (mRS ≤ 2) and unfavorable outcome (mRS: 3-6). During the telephone call follow-up, the clinician was unaware of any pertinent clinical or dCA information while examining each mRS score.
E. All tests are non-invasive.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| favorable outcome group | The favorable outcome group was defined as the modified Rankin Scale (mRS) score ≤2 in the AIS patients at 3 months after endovascular thrombectomy. |
| |
| unfavorable outcome group | The unfavorable outcome group was defined as the modified Rankin Scale (mRS) score with 3-6 in the AIS patients at 3 months after endovascular thrombectomy. |
| |
| HT group | HT group was defined as the AIS patients have hemorrhage transformation in 7 days after endovascular thrombectomy. |
| |
| non-HT group | Non-HT group was defined as the AIS patients do not have hemorrhage transformation in 7 days after endovascular thrombectomy. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| endovascular thrombectomy | Procedure | All individuals were anesthetized, with local or general anesthesia dependent on the cooperation level of the patient. During the procedure, it was mandatory to administer intravenous heparin to maintain the activated clotting time between 250 and 300 s, except for subjects who received intravenous alteplase. The procedures were performed through the femoral artery. The selection of stent retriever type and size, along with any required devices, such as guide wires and catheters, as well as the intervention strategy, was at the interventionists' discretion. |
| Measure | Description | Time Frame |
|---|---|---|
| The occurrence of hemorrhage transformation | The AIS patients have hemorrhage transformation detected by head computed tomography scans within 7 days after EVT | 7 days |
| Patients without hemorrhage transformation | The AIS patients do not have hemorrhage transformation detected by head computed tomography scans within 7 days after EVT | 7 days |
| The occurrence of unfavorable outcome | The modified Rankin Scale (mRS) score was 3-6 of AIS patients with EVT after 3 months. | 3 months |
| The occurrence of favorable outcome | The modified Rankin Scale (mRS) score ≤2 of AIS patients with EVT after 3 months. | 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| The occurrence of long-term unfavorable outcome | The modified Rankin Scale (mRS) score was 3-6 of AIS patients with EVT after 1 year. | 1 year |
| The occurrence of long-term favorable outcome | The modified Rankin Scale (mRS) score ≤2 of AIS patients with EVT after 1 year. |
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Inclusion Criteria:
Exclusion Criteria:
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Male and female patients 18 years of age and older with acute ischemic stroke who underwent endovascular thrombectomy.
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| Name | Affiliation | Role |
|---|---|---|
| Yingqi Xing, M.D. | Department of Vascular Ultrasonography, Xuanwu Hospital. | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Vascular Ultrasonography, Xuanwu Hospital of Capital Medical University | Beijing | Beijing Municipality | 100053 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32414382 | Background | Tian G, Ji Z, Huang K, Lin Z, Pan S, Wu Y. Dynamic cerebral autoregulation is an independent outcome predictor of acute ischemic stroke after endovascular therapy. BMC Neurol. 2020 May 15;20(1):189. doi: 10.1186/s12883-020-01737-w. | |
| 29129157 | Background | Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, Yavagal DR, Ribo M, Cognard C, Hanel RA, Sila CA, Hassan AE, Millan M, Levy EI, Mitchell P, Chen M, English JD, Shah QA, Silver FL, Pereira VM, Mehta BP, Baxter BW, Abraham MG, Cardona P, Veznedaroglu E, Hellinger FR, Feng L, Kirmani JF, Lopes DK, Jankowitz BT, Frankel MR, Costalat V, Vora NA, Yoo AJ, Malik AM, Furlan AJ, Rubiera M, Aghaebrahim A, Olivot JM, Tekle WG, Shields R, Graves T, Lewis RJ, Smith WS, Liebeskind DS, Saver JL, Jovin TG; DAWN Trial Investigators. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2018 Jan 4;378(1):11-21. doi: 10.1056/NEJMoa1706442. Epub 2017 Nov 11. |
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| 1 year |
| 35707901 | Result | Zhao W, Liu R, Yu W, Wu L, Wu C, Li C, Li S, Chen J, Song H, Hua Y, Ma Q, Ji X. Elevated pulsatility index is associated with poor functional outcome in stroke patients treated with thrombectomy: A retrospective cohort study. CNS Neurosci Ther. 2022 Oct;28(10):1568-1575. doi: 10.1111/cns.13888. Epub 2022 Jun 16. |
| ID | Term |
|---|---|
| D000083242 | Ischemic Stroke |
| ID | Term |
|---|---|
| D020521 | Stroke |
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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