Reduction of Edema With a Specialized Cocktail for Ultra-early Management in Ischemic Stroke

NCT06863571 | Recruiting Phase 3 DMC

• 1 other identifier: RESCUE-IS
• Study Type: interventional
• Target: 68
• Locations: 1 country
• Sites: 1

Brief Summary

Large ischemic stroke is a severe subtype of acute ischemic stroke (AIS), often leading to malignant cerebral edema, elevated intracranial pressure, and poor functional outcomes. Despite early aggressive treatment, malignant cerebral edema remains a major determinant of prognosis, even in cases of successful recanalization. Preclinical studies suggest that a pharmacological cocktail (PPA) may alleviate cerebral edema by modulating extracellular potassium balance, maintaining aquaporin-4 expression, and enhancing lymphatic drainage. This multicenter, randomized controlled trial (RCT) aims to assess the safety and efficacy of PPA in reducing cerebral edema and improving outcomes in patients with large ischemic stroke. The study will enroll 68 patients with MCA-territory infarction (80-300 mL infarct volume or ASPECTS 1-5), who are not undergoing decompressive craniectomy. Participants will be randomized to receive PPA therapy or standard treatment. The primary outcome is cerebral edema at 5-7 days, with secondary outcomes including 90-day functional outcomes (mRS) and safety assessments.

Conditions

Ischemic Stroke

Outcome Measures

Primary Outcomes (1)

• Cerebral Edema at 5-7 Days

  The primary outcome of this study is cerebral edema. Edema will be quantified using standardized imaging analysis techniques. The difference in cerebral edema between the PPA intervention group and the standard treatment group will be compared to evaluate the efficacy of the pharmacological cocktail in reducing brain swelling.

  5-7 days post-treatment

Secondary Outcomes (5)

• 90-Day Functional Outcome (Modified Rankin Scale, mRS)

  90 days post-treatment

• Incidence of Hypotension During the Treatment Period

  During the 5-day treatment period

• Need for Decompressive Craniectomy

  Up to 7 days post-treatment

• Mortality at 90 Days

  90 days post-treatment

• Incidence of Serious Adverse Events (SAEs)

  Up to 90 days post-treatment

Study Arms (2)

PPA Intervention Group

EXPERIMENTAL

Participants in this group will receive a pharmacological cocktail (PPA) for five days in addition to standard medical treatment for acute ischemic stroke. The regimen includes terazosin or urapidil, and propranolol or esmolol, with individualized blood pressure management. The specific protocol is as follows: * Terazosin (no less than 1 mg orally or via nasogastric tube, nightly) or Urapidil (100 mg in 30 mL saline, IV infusion at no less than 2 mL/h) * Propranolol (10 mg orally or via nasogastric tube, three times daily) or Esmolol (1 g in 40 mL saline, IV infusion at no less than 2 mL/h; use for no more than 48 hours. Beyond 48 hours, switch to Propranolol)

Drug: PPA Intervention

Standard Treatment Group

NO INTERVENTION

Participants in this group will receive standard medical treatment for acute ischemic stroke without the PPA intervention. This includes appropriate supportive care, blood pressure management according to clinical guidelines, and symptomatic treatment as required.

Interventions

PPA Intervention DRUG

Participants in this group will receive a pharmacological cocktail (PPA) for five days in addition to standard medical treatment for acute ischemic stroke. The regimen includes terazosin or urapidil, and propranolol or esmolol, with individualized blood pressure management. The specific protocol is as follows: * Terazosin (no less than 1 mg orally or via nasogastric tube, nightly) or Urapidil (100 mg in 30 mL saline, IV infusion at no less than 2 mL/h) * Propranolol (10 mg orally or via nasogastric tube, three times daily) or Esmolol (1 g in 40 mL saline, IV infusion at no less than 2 mL/h; use for no more than 48 hours. Beyond 48 hours, switch to Propranolol)

PPA Intervention Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age ≥18 years
• Clinical diagnosis of acute ischemic stroke (AIS) in the middle cerebral artery (MCA) territory
• Symptom onset within 3 days (≤72 hours) before randomization
• Infarct volume of 80-300 mL or ASPECTS 1-5 involving at least two cortical regions
• Not scheduled for decompressive craniectomy (either not indicated or declined by the patient/family)
• Written informed consent obtained from the patient or legally authorized representative

You may not qualify if:

• Baseline evidence of brain herniation or severe hypotension (SBP \<90 mmHg)
• Contraindications to PPA medications (terazosin, urapidil, esmolol, propranolol), such as asthma or severe bradycardia
• Severe comorbidities that may interfere with efficacy assessment or safety monitoring (e.g., end-stage organ failure, advanced malignancy)
• Pregnancy or lactation
• Participation in another interventional trial that may influence study outcomes

Sponsors & Collaborators

• Second Affiliated Hospital, School of Medicine, Zhejiang University: lead

Study Sites (1)

Second Affiliated Hospital of Zhejiang University, School of Medicine

Hangzhou, Zhejiang, 310000, China

RECRUITING

MeSH Terms

Conditions

Ischemic Stroke

Condition Hierarchy (Ancestors)

Stroke; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases

Central Study Contacts

Min Lou, PhD, MD

CONTACT

8613958007213; loumingxc@vip.sina.com

Study Design

• Study Type: interventional
• Phase: phase 3
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 3, 2025
• First Posted: March 7, 2025
• Study Start: April 12, 2025
• Primary Completion: March 10, 2026
• Study Completion (Estimated): June 30, 2026
• Last Updated: April 18, 2025

Record last verified: 2025-02

Locations

CN (1)