Title : SEACOAST 1 SEdAtion With COllAteral Support in Endovascular Therapy for Acute Ischemic Stroke 1: a Randomized Controlled Phase 2B Clinical Trial
University of California, Los Angeles
Summary
SEACOAST 1 is a prospective, randomized, blinded endpoint trial comparing collateral vigor and clinical outcomes, with different forms of GA in patients with acute ischemic stroke due to anterior circulation large vessel occlusion (LVO) undergoing mechanical thrombectomy. The study compares GA with normocarbia (GAN) versus GA with mild hypercarbia (GAH), with a primary outcome of collateral robustness at measured at catheter angiography and clinical efficacy as secondary outcome. It is anticipated that the SEACOAST 1 will be followed by a larger, pivotal trial, SEACOAST 2, with primary clinical endpoints, in which the best method of GA identified in SEACOAST 1 is compared with the alternative strategy of anesthesia care (MAC) with minimal or no sedation. The current study focuses uppn SEACOAST 1, which is to be conducted in University of California, Los Angeles Ronald Reagan Medical Center and Santa Monica Medical Center. All acute stroke patients who arrive to one of these two stroke centers and are deemed eligible for thrombectomy will be considered for the proposed study. Physician-investigators will determine study eligibility. Informed consent to participate in the study will be obtained from legally authorized representatives or competent patients. For non-competent patients without on-scene legally authorize representatives, the consent process will utilize enrollment in emergency circumstances with exemption of informed consent (EFIC).
Description
Study design: SEACOAST 1 is a prospective, randomized, blinded endpoint trial comparing collateral vigor and clinical outcomes, focusing on two distinct sedation strategies: 1. General anesthesia with mild hypercarbia (GAH) during the sedation up until full revascularization versus 2. General anesthesia with normocarbia (GAN) during the sedation up until full revascularization Neuroanesthesia protocol, focused on maintenance of baseline BP, avoidance of hypotension during induction, and targeted partial pressure of carbon monoxide (PCO2) levels (normocarbia or mild hypercarbia): * Anesthes…
Eligibility
- Age range
- 18–110 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. Age ≥18 2. NIHSS ≥ 6 within 0-16h or NIHSS ≥ 10 within 16-24h 3. Anterior circulation large vessel occlusion (ICA, M1, M2) 4. ASPECTS score ≥ 6 within the first 6h, or DEFUSE trial imaging criteria within 6-16h; or DAWN trial clinical/imaging mismatch criteria within 16-24h 5. Premorbid modified Rankin Scale (mRS) 0-2 6. Patient deemed candidate for mechanical thrombectomy with anticipated groin puncture within 24 hours of last known well and within 90 min of ED arrival Clinical Exclusion Criteria: 1. Intubation in ED prior to anesthesiologist evaluation, or intubatio…
Interventions
- OtherTight control of end-tidal CO2 levels
The desired end-tidal PCO2 levels will be achieved by endotracheal intubation and controlled ventilation
Location
- UCLA Stroke CenterLos Angeles, California