A Randomized Trial on Hemodynamic Optimization of Cerebral Perfusion after Successful Endovascular Therapy in Patients with Acute Ischemic Stroke (HOPE).

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Cerebrovascular Diseases Pub Date : 2024-08-29 DOI:10.1159/000540606
Pol Camps-Renom, Marina Guasch-Jiménez, Alejandro Martínez-Domeño, Luis Prats-Sánchez, Anna Ramos-Pachón, Juan Álvarez-Cienfuegos, Yolanda Silva, Gerardo Fortea-Cabo, Luis Morales-Caba, Ana Rodríguez-Campello, Eva Giralt-Steinhauer, Alan Flores, Xavier Ustrell, Nicolás López-Hernández, Diego José Corona-García, Mari Mar Freijo-Guerrero, Alain Luna, Herbert Tejada-Meza, Javier Marta-Moreno, Francisco Moniche, Blanca Pardo-Galiana, Mar Castellanos, Laura Albert-Lacal, Ainara Sanz-Monllor, Ana Aguilera-Simón, Rebeca Marín, Garbiñe Ezcurra-Díaz, Álvaro Lambea-Gil, Joan Martí-Fàbregas
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引用次数: 0

Abstract

Introduction: In patients with acute ischemic stroke (AIS) secondary to intracranial large vessel occlusion, optimal blood pressure (BP) management following endovascular treatment (EVT) has not yet been established. The randomized trial on Hemodynamic Optimization of Cerebral Perfusion after Successful Endovascular Therapy in Patients with Acute Ischemic Stroke (HOPE) (clinicaltrials.gov id: NCT04892511) aims to demonstrate whether hemodynamic optimization using different systolic BP targets following EVT according to the degree of final recanalization, is more effective than currently recommended BP management in improving functional outcomes of patients with AIS.

Methods: HOPE is an investigator-initiated multicenter clinical trial with randomized allocation, open-label treatment, and blinded endpoint evaluation (PROBE). Patients with an anterior circulation AIS within 24 h of symptom onset, treated with EVT, and showing successful recanalization (mTICI ≥2b) at the end of the procedure, are equally allocated (1:1) to hemodynamic optimization according to the study protocol versus BP management according to current guidelines (≤180/105 mm Hg). The protocol includes two different targets of systolic BP depending on the recanalization status (mTICI = 2b: 140-160 mm Hg; mTICI = 2c/3: 100-140 mm Hg). The protocol is applied within the first 72 h and includes BP lowering as well as vasopressor therapies when needed. The primary outcome is the proportion of favorable outcome (modified Rankin Scale [mRS] 0-2) at 90 days. Secondary outcomes include the shift on the mRS score, neurological deterioration, symptomatic intracerebral hemorrhage, and mortality.

Conclusion: The HOPE trial will provide new information on the safety and efficacy of different BP targets following EVT according to the degree of final recanalization in patients with AIS.

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急性缺血性中风患者血管内治疗成功后脑灌注血液动力学优化随机试验 (HOPE)。
导言:对于继发于颅内大血管闭塞(LVO)的急性缺血性卒中(AIS)患者,血管内治疗(EVT)后的最佳血压(BP)管理尚未确定。急性缺血性卒中患者血管内治疗成功后脑灌注血流动力学优化随机试验(HOPE)(clinicaltrials.方法:HOPE 是一项由研究者发起的多中心临床试验,采用随机分配、开放标签治疗和盲法终点评估 (PROBE)。症状出现后24小时内出现前循环AIS、接受EVT治疗并在手术结束时显示成功再通畅(mTICI≥2b)的患者,将按照研究方案与现行指南规定的血压管理(≤180/105mmHg)进行平均分配(1:1)。根据再通畅状况,该方案包括两种不同的收缩压目标(mTICI=2b:140-160 mmHg;mTICI=2c/3:100-140 mmHg)。治疗方案在最初的 72 小时内实施,包括降压以及必要时的血管加压疗法。主要结果是 90 天后的良好预后比例(修正的 Rankin 量表 [mRS] 0-2)。次要结果包括 mRS 评分的变化、神经功能恶化、症状性脑出血和死亡率:HOPE试验将为AIS患者EVT后根据最终再通畅程度选择不同血压目标值的安全性和有效性提供新的信息。
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来源期刊
Cerebrovascular Diseases
Cerebrovascular Diseases 医学-临床神经学
CiteScore
4.50
自引率
0.00%
发文量
90
审稿时长
1 months
期刊介绍: A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.
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