Managing blood pressure during clot retrieval for stroke treatment

MAnagement of Systolic Blood Pressure During Thrombectomy by Endovascular Route for Acute Ischaemic STROKE: the MASTERSTROKE Trial

This study is testing whether keeping blood pressure in a certain range during a stroke treatment can help patients recover better and have less long-term disability.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 550 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Auckland City Hospital (Government)
• Locations: 4 sites (Woolloongabba, Queensland and 3 other locations)
• Trial ID: NCT05645861 on ClinicalTrials.gov

What this trial studies

This clinical trial investigates the management of systolic blood pressure (SBP) during endovascular thrombectomy (EVT) for patients with acute ischaemic stroke. The study aims to determine the safety and efficacy of maintaining SBP within a target range during general anaesthesia, as current practices lack clear guidelines on blood pressure management during this critical procedure. By comparing two different SBP management strategies, the trial seeks to enhance patient outcomes and reduce long-term disability associated with stroke. The research is particularly relevant given the increasing burden of stroke as a leading cause of disability worldwide.

Who should consider this trial

Good fit: Ideal candidates include patients diagnosed with anterior circulation stroke who are treated with endovascular clot retrieval within 6 hours of stroke onset or within 6-24 hours with favorable imaging results.

Not a fit: Patients with pre-existing severe disability, terminal illness, or those not undergoing general anaesthesia may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could improve recovery outcomes and reduce disability for patients undergoing clot retrieval for stroke.

How similar studies have performed: While there is limited guidance on blood pressure management during EVT, the study builds on existing observational data, indicating a need for more rigorous investigation in this area.

Eligibility criteria

Inclusion Criteria:

* Patients diagnosed with anterior circulation stroke (ICA or proximal M1 or M2 segment of MCA) treated with ECR within 6 hrs of stroke onset and ECR patients presenting within 6-24 hours and favourable penumbra on perfusion scanning (see criteria 1-3).

Additional criteria in the 6 to 24-hour window.

1. 'wake up' stroke; CT with no (or at most minimal) acute infarction or
2. patient 80 years or older (NIHSS of 10 and infarct volume less than 21 ml on DWI or CT perfusion-CBF)
3. patient less than 80 years (NIHSS of 10 and infarct volume less than 31 ml on DWI or CT perfusion-CBF NIHSS of 20 and infarct volume less than 51 ml on DWI or CT perfusion-CBF).

Exclusion Criteria:

* Rescue"' procedures eg acute ischaemic stroke associated with major medical procedures such as coronary artery stenting and coronary artery bypass

  * pre-stroke mRS\>=3
  * not having GA
  * terminal illness with expected survival \<1 year
  * pregnancy
  * cardiovascular conditions where BP targeting will be contra-indicated
  * unable to participate in 3-month follow up

Where this trial is running

Woolloongabba, Queensland and 3 other locations

• Metro South Hospital and Health Service via the Princess Alexandra Hospital — Woolloongabba, Queensland, Australia (Not_yet_recruiting)
• Christchurch Hospital — Christchurch, Canterbury, New Zealand (Recruiting)
• Wellington Regional Hospital — Newton, Wellington, New Zealand (Recruiting)
• Auckland City Hopsital — Auckland, New Zealand (Recruiting)

Study contacts

• Principal investigator: Doug Campbell, Dr — Auckland City Hospital
• Study coordinator: Davina J McAllister, DipNursing

Conditions Stroke; Embolus Cerebral; Blood Pressure