Research Project: Blood pressure (BP) management after endovascular mechanical thrombectomy (EVT) for
large vessel acute ischemic stroke (AIS) can critically influence brain reperfusion, and thereby patient
outcomes. Current guidelines recommend allowing higher than normal BP in the 24 hrs after an EVT without
strong evidence. Our preliminary results demonstrate that lower post-EVT systolic BP (SBP) associate with
better outcomes. Although low SBP targets are assumed to compromise brain perfusion, no data exist to
definitely demonstrate any relationship of harm with post-EVT SBP targets. Such safety assessment of lower
SBP targets is a critical prerequisite to conduct larger studies to evaluate their efficacy in improving outcomes
of EVT-treated patients. We will conduct the Blood Pressure after Endovascular Stroke Therapy-II (BEST-II)
trial, where 120 AIS patients successfully treated with an EVT will be randomized to three SBP targets (£180,
<160, and <140 mmHg) to 1) assess the harm of lower SBP targets and 2) determine the probability
(hypothesized to be ³25%) of a positive phase III efficacy trial of lower SBP targets to improve patient
outcomes. To assess the harm, we will test the null hypotheses that lower SBP targets do not worsen brain
ischemia or 90-day functional outcome in patients beyond a level considered safe. This proposal will generate
high quality data for the planning of a large, multicenter efficacy trial. Collectively, this set of trials will lead to
evidence-based guideline generation for the optimal post-EVT BP management in AIS patients.
Candidate: Working close with her mentors over the past two years, Dr. Eva Mistry designed, led, and
successfully completed a large, prospective, multi-institutional study (BEST-I) to demonstrate the association
of improved outcomes with lower SBP in EVT-treated AIS patients. This proposal is the direct result of this
preliminary work. Her long-term goal is to be a leader in novel designs and electronic facilitation of acute stroke
trials to ensure efficient testing of new stroke treatments and improve patient outcomes.
Career Development: To achieve her long-term goal, Dr. Mistry will follow an integrated career development
plan. Her rigorous training will include coursework, personalized mentoring from mentors and advisors, and
experiential training to achieve mastery in 1) trial implementation in acute and critical care settings, 2) adaptive
and platform trial designs, 3) electronic facilitation of clinical trials, and 4) leadership skills.
Environment: Vanderbilt University Medical Center (VUMC) is the largest comprehensive stroke center in the
middle Tennessee and performs over 100 EVTs annually. As a Clinical and Translational Science Awarded
institution with a large pool of NIH-funded investigators and leaders in acute and critical care clinical trials,
novel trial designs, biostatistics, and clinical informatics, VUMC provides an ideal environment with myriad
opportunities and support resources for Dr. Mistry to successfully accomplish her research and career goals to
become an independent investigator.