The Preliminary Efficacy and Safety of Intra-Arterial Albumin as Adjunct to Mechanical Thrombectomy in Acute Ischemic Stroke

Official title

The Preliminary Efficacy and Safety of Intra-Arterial Albumin as Adjunct to Mechanical Thrombectomy in Acute Ischemic Stroke：Dual-Center, Prospective, Open-Label, Endpoint-Blinded, Randomized Controlled Clinical Trial

Overview

Albumin-assisted therapy has demonstrated good safety and potential neuroprotective effects following mechanical thrombectomy. To further systematically evaluate its efficacy and safety, we are conducting a Phase IIa clinical trial of intra-arterial albumin administration combined with mechanical thrombectomy in patients with acute ischemic stroke. This is a double-center, prospective, open-label, endpoint-blinded, randomized controlled trial designed to preliminarily assess the efficacy and safety of intra-arterial infusion of 20% human albumin after successful recanalization in patients with acute ischemic stroke caused by anterior circulation large-vessel occlusion who undergo mechanical thrombectomy. A total of 60 patients will be enrolled and randomized in a 1:1 ratio by dynamic minimization into two groups: the albumin group (0.6 g/kg of 20% human albumin solution plus mechanical thrombectomy) and the control group (mechanical thrombectomy alone). The primary objective of this study is to preliminarily evaluate whether intra-arterial infusion of 0.6 g/kg of 20% human albumin via the internal carotid artery immediately after achieving successful recanalization (eTICI ≥ 2b) can reduce infarct volume compared with mechanical thrombectomy alone in patients with anterior circulation large-vessel occlusion who undergo standard mechanical thrombectomy. The secondary objective is to assess the safety and feasibility of intra-arterial infusion of 0.6 g/kg of 20% human albumin immediately after successful recanalization in this patient population.

Interventions

• Drug Human serum albumin infusion 20%
  20% human albumin solution at a dose of 0.60 g/kg will be administered as a constant-rate infusion into the proximal internal carotid artery over 20 minutes.

Primary outcome measures

• Growth in infarct volume at 24 (±6) hours after randomization compared to baseline [Time frame: at 24 (±6) hours after randomization]

Secondary outcome measures (12)

• Proportion of favorable functional outcome at 90 (±14) days, defined as mRS 0-2 [Time frame: at 90 (±14) day after randomizatio]
• Infarct volume at 24 (±6) hours [Time frame: at 24 (±6) hours after randomization]
• Proportion of excellent functional at 90 (±14) days, defined as mRS 0-1 [Time frame: at 90 (±14) day after randomization]
• mRS score at 90 (±14) days [Time frame: at 90 (±14) days after randomization]
• Vessel recanalization at 24 (±6) hours [Time frame: at 24 (±6) hours after randomization]
• NIHSS score at 24 (±6) hours [Time frame: at 24 (±6) hours after randomization]
• NIHSS score at 7 (±1) days/at discharge [Time frame: at 7 (±1) days/at discharge after randomization]
• EQ-5D-5L at 90 (±14) days [Time frame: at 90 (±14) days after randomization]
• Proportion of Barthel Index ≥95 at 90 (±14) days [Time frame: at 90 (±14) days after randomization]
• Incidence of all-cause death within 90 (±14) days [Time frame: at 90 (±14) days after randomization]
• Incidence of symptomatic intracranial hemorrhage within 24 (±6) hours [Time frame: at 24 (±6) hours after randomization]
• Incidence of intracranial hemorrhage within 24 (±6) hours [Time frame: at 24 (±6) hours after randomization]

Eligibility criteria

Inclusion criteria

• 1.Age ≥ 18 years; 2.ICA or MCA-M1 occlusion, confirmed by preoperative CTA/MRA/DSA. ICA occlusion can be cervical or intracranial, with or without tandem MCA lesions; Treated with EVT resulting in recanalization ((expanded Thrombolysis in Cerebral Infarction \[eTICI\] 2b-3); 3.Baseline NIHSS scores ≥ 6; 4.Baseline ASPECTS ≥6 on non-contrast CT; 5.The time from stroke onset/last seen well to arterial puncture is within 24 hours; 6.No significant pre-stroke disability (pre-stroke mRS ≤2); 7.Signed informed consent from the patient or the legally authorized representative

Exclusion criteria

• 1.Presence of intracranial hemorrhage on head CT or MRI； 2.Midline shift with significant mass effect on head CT or MRI； 3.History of heart failure or severe cardiovascular disease, including but not limited to pulmonary hypertension, pericardial effusion, etc； 4.Arrhythmia accompanied by hemodynamic instability； 5.Symptoms or electrocardiographic evidence of acute myocardial infarction upon admission； 6.Acute or chronic renal failure (serum creatinine >2.0 mg/dL)； 7.Severe anemia (hematocrit <32%)； 8.Known allergy to albumin or blood products； 9.Pregnant women； 10.Persistent blood pressure ≥180/100 mmHg prior to albumin infusion； 11.Concurrent participation in another clinical trial； 12.Life expectancy of less than 3 months； 13.Coexisting severe pulmonary diseases such as Chronic Obstructive Pulmonary Disease, pulmonary fibrosis, pleural effusion, pulmonary hypertension, or acute respiratory distress syndrome； 14.Any other condition that, in the opinion of the investigator, makes the patient unsuitable for participation in this study.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Center list to be confirmed — check the primary protocol.

Identifiers

NCT: NCT07294391 · TJHH_WM_20251125

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗