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NCT04116112: BEST-II

Blood Pressure After Endovascular Stroke Therapy-II

Completed Phase 2 Results posted Last updated 12 October 2023
What this trial tests

Phase 2 trial testing Nicardipine in Acute Stroke in 120 participants. Completed in 15 December 2022.

Timeline
17 January 2020
Primary endpoint
1 July 2022
15 December 2022

Quick facts

Lead sponsorUniversity of Cincinnati
PhasePhase 2
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingsingle
Primary purposetreatment
Enrollment120
Start date17 January 2020
Primary completion1 July 2022
Estimated completion15 December 2022
Sites3 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

University of Cincinnati

Who can join

18 and older, any sex, with Acute Stroke or Endovascular Thrombectomy. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Final Infarct Volume Primary · 36 (+/-12) hrs after treatment initiation

Infarct volume on diffusion-weighted MRI (or CT if MRI cannot be obtained) at 36 (+/-12) hrs after treatment initiation, adjusted for the baseline CT perfusion core infract volume.

GroupValue95% CI
Higher Systolic Blood Pressure (SBP) Target46.424.5 – 68.2
Lower SBP (<160 mmHg) Target50.733.7 – 67.7
Lower SBP (<140mmHg) Target32.418.0 – 46.7
Utility-weighted Modified Rankin Score Primary · 90 days after treatment initiation

Modified Rankin score (mRS) is a scale for measuring the degree of disability or dependence of people who have suffered a stroke. 0 - no symptoms at all; 1 - no significant disability despite symptoms; able to carry out all usual duties and activities; 2- slight disability; unable to carry out all previous activities, but able to look after own affairs without assistance; 3- moderate disability; requiring some help, but able to walk without assistance; 4 - moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance; 5 - severe dis

GroupValue95% CI
Higher Systolic Blood Pressure (SBP) Target0.580.46 – 0.71
Lower SBP (<160 mmHg) Target0.470.35 – 0.6
Lower SBP (<140mmHg) Target0.510.38 – 0.63
Number of Participants With Any Hemorrhagic Transformation Secondary · 36(+/-12) hrs after treatment initiation

Number of participants with any new bleeding within the infarcted brain tissue on 36(+/-12) hr MRI/CT scan after treatment initiation

GroupValue95% CI
Higher Systolic Blood Pressure (SBP) Target12
Lower SBP (<160 mmHg) Target12
Lower SBP (<140mmHg) Target14
Number of Participants With Symptomatic Hemorrhagic Transformation Secondary · 36(+/-12) hrs after treatment initiation

Defined as number of participants with any new bleeding within the infarcted brain tissue and an NIH Stroke Scale worsening of 4 or more points associated with the bleeding within 36 (+/-12) hrs of treatment initiation

GroupValue95% CI
Higher Systolic Blood Pressure (SBP) Target2
Lower SBP (<160 mmHg) Target1
Lower SBP (<140mmHg) Target2
Number of Participants With Neurological Worsening Associated With Antihypertensive Treatment Secondary · Treatment initiation to 24 hrs after treatment initiation

Defined as number of participants with 4 points of greater increase in NIH Stroke scale associated with reduction in SBP caused by anti-hypertensive treatment initiation or titration.

GroupValue95% CI
Higher Systolic Blood Pressure (SBP) Target0
Lower SBP (<160 mmHg) Target0
Lower SBP (<140mmHg) Target0

Adverse events — posted to ClinicalTrials.gov

Time frame: Through hospital stay, up to 30 days. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Higher Systolic Blood Pressure (SBP) Target
Serious: 1/40 (3%)
Deaths: 3/40
Lower SBP (<160 mmHg) Target
Serious: 3/40 (8%)
Deaths: 6/40
Lower SBP (<140mmHg) Target
Serious: 4/40 (10%)
Deaths: 3/40

Serious adverse events (7 terms)

ReactionSystemHigher Systolic Blood Pres…Lower SBP (<160 mmHg) TargetLower SBP (<140mmHg) Target
Aspiration PneumoniaInfections and infestations
Femoral artery PseudoaneurysmVascular disorders
Sepsis and cardiac failureInfections and infestations
Carotid artery re-occlusionVascular disorders
Subarachnoid hemorrhageNervous system disorders
Gastrointestinal hemorrhage associated with gastric ulcerGastrointestinal disorders
New contralateral large vessel occlusion strokeNervous system disorders

Most-reported serious reactions: Aspiration Pneumonia, Femoral artery Pseudoaneurysm, Sepsis and cardiac failure, Carotid artery re-occlusion, Subarachnoid hemorrhage, Gastrointestinal hemorrhage associated with gastric ulcer, New contralateral large vessel occlusion stroke.

Data from ClinicalTrials.gov NCT04116112 adverse events section.

Sponsor's own description

The purpose of this study is to assess the safety of lowering blood pressure in acute stroke patients that are successfully treated with a mechanical thrombectomy procedure. The investogators will evaluate the hypothesis that lower blood pressure management strategies do not result in larger volume of stroke or worse 3-month clinical outcome in these patients.

Publications & conference data

8 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Intensive vs Conventional Blood Pressure Lowering After Endovascular Thrombectomy in Acute Ischemic Stroke: The OPTIMAL-BP Randomized Clinical Trial.
    Nam HS, Kim YD, Heo J, Lee H, et al · · 2023 · cited 120× · PMID 37668619 · DOI 10.1001/jama.2023.14590
  2. Integrated care for optimizing the management of stroke and associated heart disease: a position paper of the European Society of Cardiology Council on Stroke.
    Lip GYH, Lane DA, Lenarczyk R, Boriani G, et al · · 2022 · cited 102× · PMID 35552401 · DOI 10.1093/eurheartj/ehac245
  3. Blood Pressure Management After Endovascular Therapy for Acute Ischemic Stroke: The BEST-II Randomized Clinical Trial.
    Mistry EA, Hart KW, Davis LT, Gao Y, et al · · 2023 · cited 90× · PMID 37668620 · DOI 10.1001/jama.2023.14330
  4. Intracranial Hemorrhage After Reperfusion Therapies in Acute Ischemic Stroke Patients.
    Maïer B, Desilles JP, Mazighi M. · · 2020 · cited 64× · PMID 33362701 · DOI 10.3389/fneur.2020.599908
  5. Blood Pressure in the First 6 Hours Following Endovascular Treatment for Ischemic Stroke Is Associated With Outcome.
    Samuels N, van de Graaf RA, van den Berg CAL, Uniken Venema SM, et al · · 2021 · cited 26× · PMID 34538090 · DOI 10.1161/strokeaha.120.033657
  6. Blood Pressure Management After Endovascular Thrombectomy.
    Peng TJ, Ortega-Gutiérrez S, de Havenon A, Petersen NH. · · 2021 · cited 20× · PMID 34539562 · DOI 10.3389/fneur.2021.723461
  7. Impact of Blood Pressure After Successful Endovascular Therapy for Anterior Acute Ischemic Stroke: A Systematic Review.
    Maïer B, Delvoye F, Labreuche J, Escalard S, et al · · 2020 · cited 16× · PMID 33193021 · DOI 10.3389/fneur.2020.573382
  8. Neurocritical Care Updates in Cerebrovascular Disease.
    Jha RM, Sheth KN. · · 2021 · cited 3× · PMID 34111948 · DOI 10.1161/strokeaha.121.033291

Verify or expand the search:

Other trials of Nicardipine

Trials testing the same drug.

Other recruiting trials for Acute Stroke

Currently open trials in the same condition.

Other University of Cincinnati trials

Trials by the same sponsor.

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