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Acute Ischemic StrokePhase 3NCT06677970

Outcome in Patients Treated With Endovascular Thrombectomy - optIMAL Blood Pressure Control 2 (OPTIMAL-BP 2)

A Phase 3 study testing BP lowering drugs (nicardipine, labetalol, urapidil) and BP raising drug (phenylephrine) or BP lowering drugs (nicardipine, labetalol, urapidil) in people with Acute Ischemic Stroke, run by Yonsei University at 1 site in South Korea.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Though intravenous thrombolysis has been shown to improve symptoms in acute ischemic stroke patients, the recanalization rate remains low (22.6%) and only around 30% of patients benefit from the treatment. Read more about this study

Who is it for?
Ages 20 years and older
Conditions the study is for
Acute Ischemic Stroke
What is being tested?
BP lowering drugs (nicardipine, labetalol, urapidil) and BP raising drug (phenylephrine) or BP lowering drugs (nicardipine, labetalol, urapidil)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
176 participants
Where
1 siteSouth Korea
Study dates
1 Oct 2024to 3 Dec 2029
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 20 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

<Inclusion Criteria>

  1. Age ≥20 years
  2. Acute ischemic stroke patients who underwent intraarterial thrombectomy for large vessel occlusion. (ICA, M1, M2, A1, P1, VA and BA)
  3. Patients with successful recanalization after intraarterial thrombectomy (TICI 2b or TICI 3)
  4. Patients with sustained systolic blood pressure (SBP) <150 mm Hg on successive measurements obtained less than 10 minutes apart within 3 hours after reperfusion.
  5. Patients with mean SBP <150 mmHg within 2 hours after successful recanalization (two measurements ≥2 minutes apart).

<Exclusion Criteria>

  1. Age <20
  2. Patients who failed recanalization of the intracranial artery after endovascular thrombectomy (modified TICI ≤ 2a).
  3. Patients with systolic blood pressure ≥ 150 mmHg after successful recanalization.
  4. Patients unable to receive antihypertensive medication post-thrombectomy or in whom the investigator believes aggressive blood pressure control could have adverse effects, such as increased risk of hemorrhage.
  5. Patients who developed symptomatic intracranial hemorrhage before study enrollment, after successful recanalization.
  6. Patients with contraindications to Phenylephrine.
  7. Patients with contraindications to antihypertensive medications.
  8. Patients with pre-stroke functional disability (modified Rankin Scale, mRS ≥3).
  9. Patients with heart failure and reduced cardiac output, with an ejection fraction (EF) <40%.
  10. Patients with end-stage renal disease requiring renal replacement therapy, or chronic kidney disease stage 4 with an eGFR <30 mL/min.
  11. Patients currently taking monoamine oxidase (MAO) inhibitors.
  12. Patients with persistent bradycardia with a heart rate <45 bpm.
  13. Pregnant patients.
  14. Patients with severe medical or surgical comorbidities, including but not limited to: terminal cancer with life expectancy <6 months, severe cardiac or aortic disease, severe hematologic disorders, advanced chronic heart failure, severe pneumonia, or sepsis.
  15. Patients who do not consent to participate in the study.
  16. Patients participating in another study that does not allow co-enrollment.
  17. Patients whom the investigator deems unsuitable for study participation for any reason.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Hyo Suk Nam, MD,PhD contact

82-2-2228-1617

hsnam@yuhs.ac

South Korea1 site, 1 recruiting
  • Department of Neurology, Yonsei University College of Medicine

    Seoul, Seoul, 120-752

    Hyo Suk Nam, MD, PhD, +82 02 2228 1617, hsnam@yuhs.ac

    Recruiting

Other trials in South Korea

About this study

Though intravenous thrombolysis has been shown to improve symptoms in acute ischemic stroke patients, the recanalization rate remains low (22.6%) and only around 30% of patients benefit from the treatment. Recently, endovascular thrombectomy using stent retrievers or catheters has proven to be more effective, with a success rate of nearly 80%. However, only 50% of patients experience clinical improvement, highlighting the need for new treatment strategies to enhance outcomes. Current guidelines recommend maintaining systolic blood pressure (BP) below 180 mmHg after thrombectomy, but there is a lack of evidence regarding optimal blood pressure management post-reperfusion.

Four randomized clinical trials, including the OPTIMAL-BP trial, have examined blood pressure control following thrombectomy. Meta-analyses showed that intensive BP lowering did not reduce symptomatic hemorrhage and was associated with worse functional outcomes at 3 months. Specifically, lowering BP too aggressively after successful reperfusion could worsen outcomes by reducing perfusion to the ischemic penumbra. Therefore, this study will investigate whether a more targeted blood pressure elevation strategy could improve patient prognosis compared to standard BP control in patients with sustained systolic blood pressure (SBP) <150 mmHg on successive measurements obtained less than 10 minutes apart within 3 hours after reperfusion.

This is a prospective, randomized, open-label trial with blinded endpoint assessment (PROBE) design, aimed at comparing intensive and standard BP control strategies in acute ischemic stroke patients. Participants will be randomized 1:1 into either an intensive BP control group (targeting a 20% systolic BP increase, capped at less than 160 mmHg) or a standard BP control group (systolic BP at or below 180 mmHg).

Read the detailed description
  1. This is a prospective, randomized, open-label trial with blinded endpoint assessment (PROBE) design.
  2. Participants will be randomly assigned in a 1:1 ratio to either an intensive BP control group (targeting a 20% increase from baseline systolic BP, capped at less than 160 mmHg) or a standard BP control group (maintaining systolic BP at or below 180 mmHg).
  3. Randomization: Allocation will be stratified by stroke severity (NIHSS <15 or ≥15) and participating study center. Randomization will be conducted via a web-based system using a pre-generated randomization table created by a statistician. Investigators will enter stratification variables (study center, NIHSS score) into the system to receive the randomized allocation.
  4. This is a multi-center prospective study involving patients admitted to participating hospitals for acute ischemic stroke between October 2024 and December 2029 (last visit date). The study will include patients who undergo successful intra-arterial reperfusion therapy based on current stroke guidelines.
  5. Data collection will include the medical history, imaging findings, BP parameters (systolic BP, diastolic BP, BP variability), neurological scores, functional recovery, and quality of life (QoL) measures for eligible participants.
  6. Neurological scores, functional recovery, and QoL assessments will be conducted by independent evaluators who are blinded to treatment allocation.
  7. All data will be collected using electronic case report forms (e-CRF), and anonymized imaging data will be sent to the coordinating center.
  8. The coordinating center will perform blinded quantification of imaging results.
Being tested
BP lowering drugs (nicardipine, labetalol, urapidil), BP raising drug (phenylephrine) or BP lowering drugs (nicardipine, labetalol, urapidil)
Keywords
Blood pressure, Ischemic stroke, thrombectomy, outcome
Medical subject headings
Ischemic Stroke

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • BP lowering drugs (nicardipine, labetalol, urapidil)Drug

    After successful reperfusion, appropriate antihypertension medication is administered to control systolic blood pressure <180 mmHg.

  • BP raising drug (phenylephrine) or BP lowering drugs (nicardipine, labetalol, urapidil)Drug

    After successful reperfusion, appropriate BP raising (20% increase in SBP, maximum of 160 from baseline SBP) are administered.

Study groups in NCT06677970
Study groupRoleWhat they receive
Conventional BP magnagement group (SBP ≤180 mmHg)Active comparatorNot described
Receives: Drug: BP lowering drugs (nicardipine, labetalol, urapidil)
Intensive BP raising group (20% increase in SBP, maximum of 160 mmHg )Active comparatorNot described
Receives: Drug: BP raising drug (phenylephrine) or BP lowering drugs (nicardipine, labetalol, urapidil)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Functinal independence

    Proportion of patients with a functional independence (defined as mRS ≤ 2) at 3 months, assessed using the modified Rankin Scale (mRS).

    Measured: 3 months

  2. Symptomatic Intracranial Hemorrhage (sICH)

    Symptomatic Intracranial Hemorrhage (sICH) after Endovascular Treatment Intracranial hemorrhage or hemorrhagic transformation identified on MRI (GRE or SWI) or CT within 24 ± 12 hours or due to clinical worsening.

    (Symptomatic intracranial hemorrhage is defined according to the European Cooperative Acute Stroke Study III [ECASS III] criteria)

    Measured: 36 hours

  3. Stroke related death

    Stroke related death within 3 months

    Measured: 3 months

Secondary outcomes (32)
  1. Shift analysis of mRS score distribution.

    Distributional analysis of the modified Rankin Scale (mRS) scores to assess overall functional outcome shift between treatment groups.

    Measured: 3 months

  2. NIHSS score at 24 hours after endovascular treatment.

    Difference in National Institutes of Health Stroke Scale (NIHSS) scores between at 24 hours post-EVT.

    Measured: 24 hours

  3. Major Neurological Improvement at 24 hours, defined as either an NIHSS score of 0-1 or an improvement of 8 or more points.

    Proportion of patients achieving substantial neurological recovery within 24 hours after EVT.

    Measured: 3 months

  4. Sustained vessel recanalization on CTA/MRA at 24 hours

    Evaluation of angiographic reperfusion status (modified Thrombolysis in Cerebral Infarction [mTICI] grade ≥2b)

    Measured: Discharge and 1 month

  5. Proportion of functional independence at 1 month.

    Percentage of patients achieving mRS 0-2 at 1 month.

    Measured: 3 months

  6. Differences in Euro-Q5 instrument.

    Differences in scores measured by Euro-Q5 scale.

    Measured: 36 hours to 1 week

  7. Incidence of malignant cerebral edema.

    Frequency of radiologically or clinically confirmed malignant cerebral edema after EVT.

    Measured: 36 hours

  8. Infarction volumes

    Proportion of functional independence according to infarction volumes in DWI

    Measured: 36 hours

  9. Using intravenous BP lowering drug

    Proportion of functional independence according to intrvenous BP lowering drug

    Measured: 3 months

  10. Medication induced BP drop

    Proportion of functional independence according to medication inuced BP drop

    Measured: 3 months

  11. Collateral circulation measured by Tan scale (good collateral is defined as Tan scale 2-3) in baseline CTA.

    Proportion of functional independence according to the degree of collateral flow

    Measured: 3 months

  12. Variability in blood pressure (e.g., standard deviation, coefficient of variation, VIM, successive variation, and threshold).

    Evaluation of outcome associations with multiple BP variability indices

    Measured: 3 months

  13. Outcome comparison by baseline ischemic core burden measured with ASPECTS.

    Proportion of functional independence according to the ASPECTS (Alberta Stroke Program Early CT Score) on CT or MRI.

    Measured: 3 months

  14. Evaluation of differential outcomes in patients who received IV tPA before EVT.

    Proportion of functional independence according to prior tPA administration.

    Measured: 3 months

  15. Comparison of outcomes according to presence or severity of intracranial atherosclerotic stenosis.

    Proportion of functional independence according to intracranial arterial stenosis.

    Measured: 3 months

  16. Assessment of outcome differences by number of thrombectomy passes.

    Proportion of functional independence according to multiple attempts at endovascular recanalization.

    Measured: 3 months

  17. Evaluation of outcomes relative to attainment and timing of post-EVT BP target.

    Proportion of functional independence according to achieving the target blood pressure and the time to target on outcomes.

    Measured: 3 months

  18. Outcome comparison by initial angiographic reperfusion grade before BP intervention.

    Proportion of functional independence according to baseline mTICI scores.

    Measured: 3 months

  19. Assessment of outcome differences between patients with and without early neurological worsening.

    Proportion of functional independence according to neurological deterioration (NIHSS worsening by ≥4 points).

    Measured: 3 months

  20. Evaluation of outcomes stratified by occlusion site (e.g., ICA, M1, M2).

    Proportion of functional independence according to the occluded vessel involved.

    Measured: 3 months

  21. Biochemical markers including D-dimer, CRP, or glucose

    Proportion of functional independence according to laboratory findings including D-dimer, CRP, or glucose.

    Measured: 3 months

  22. Evaluation of vascular stiffness as a determinant of post-EVT outcomes.

    Proportion of functional independence according to estimated pulse wave velocity (ePWV).

    Measured: 3 months

  23. Small artery disease - white matter hyperintensity

    Proportion of functional independence according to degree of white matter hyperintensity

    Measured: 3 months

  24. Small artery disease - microbleeds

    Proportion of functional independence according to number of microbleeds

    Measured: 3 months

  25. Small artery disease - old lacunar infarction

    Proportion of functional independence according to number of old lacunar infarctions

    Measured: 3 months

  26. Optimal target BP according to AI predicting for functional independence in 10 mmHg increments

    Model-based identification of the optimal SBP target range predicted by AI for favorable outcomes.

    Measured: 3 months

  27. Occurrence of adverse event or serious adverse event

    Incidence and type of adverse events

    Measured: 3 months

  28. Treatment failure, defined as failure to achieve target blood pressure on two consecutive measurements within 24 hours after endovascular therapy.

    Rate of unsuccessful BP target attainment during the acute post-procedure period.

    Measured: 24 hours

  29. Differences in BP variability depending on the antihypertensive agent use (labetalol or nicardipine).

    Comparison of short-term BP stability between BP medication used for post-EVT management.

    Measured: 24 hours

  30. Differences in causes of death.

    Comparison of mortality causes

    Measured: 3 months

  31. Diffrences in fuctional outcomes at 1 year.

    Difference in 1-year functional outcomes according to mRS and EQ-5D-5L.

    Measured: 1 year

  32. Euro-Q5-5L analogue scale.

    Differnec in scores measured by Euro-Q5 scale.

    Measured: 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Nov 2024
  2. Study start1 Oct 2024
  3. Primary completion3 Dec 2029 (estimated)
  4. Study completion3 Dec 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
a multicenter, randomized, open Lable, blinded end-point clinical trial.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
176 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06677970
Sponsor's protocol ID
4-2024-0880
Status last verified
Feb 2026
First submitted
23 Sep 2024
Last updated
13 Feb 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: After study competition, the participating researcher can submitt the proposal. Publication committee will evaluate the proposal and approve it. After approval, patients data will be shared with researcher.

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing BP lowering drugs (nicardipine, labetalol, urapidil) and BP raising drug (phenylephrine) or BP lowering drugs (nicardipine, labetalol, urapidil) in people with Acute Ischemic Stroke, run by Yonsei University at 1 site in South Korea.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 13 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in South Korea. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Hyo Suk Nam, MD,PhD (82-2-2228-1617, hsnam@yuhs.ac), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Functinal independence (time frame: 3 months). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Feb 2026.

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