Australasian Nanoparticle-mediated Magnetically Enhanced Diffusion for Ischemic Stroke
- Conditions
- StrokeIschemic Stroke
- Interventions
- Device: Magnetically enhanced diffusion
- Registration Number
- NCT06495671
- Lead Sponsor
- University of Melbourne
- Brief Summary
Rapidly restoring blood flow to the brain in patients with stroke caused by a blocked blood vessel in the brain is the key to reducing disability. Current treatments often leave small blocked arteries that cannot be safely opened with mechanical clot removal devices. Furthermore, stagnant flow limits access of clot-dissolving medication to the clot. This trial tests iron nanoparticles (similar to iron infused to replace low body stores but injected directly into the brain artery upstream of the blockage) combined with an external rotating magnet that draws the nanoparticles towards the clot, overcoming stagnant blood flow. The aim is to bring fresh blood which contains naturally-occurring clot-dissolving substances, and any clot-dissolving medication that may be circulating, to the surface of the clot with the aim of restoring blood flow to the brain. The trial will recruit up to 30 patients. All will receive injection of nanoparticles via an angiogram (small tube inserted into a leg or arm artery and fed up into the brain artery under Xray control). The procedure takes 30min and the degree of success in opening the artery at the end of procedure is the primary outcome, combined with an absence of symptomatic brain bleeding at 24h.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 30
- Patients presenting with ischemic stroke within 24 hours of the time they were last known to be well
- Patient's age is ≥18 years
- Legal requirements for consent as per local legislative requirements are satisfied.
- Distal medium vessel intracranial arterial occlusion visible on CT-angiography, MR-angiography or catheter digital subtraction angiography (DSA) in the middle cerebral, anterior or posterior cerebral artery. The occlusion may be primary or secondary (ie following initial mechanical thrombectomy of a large vessel occlusion)
- Intracranial hemorrhage (ICH) identified by CT or MRI
- Rapidly improving symptoms at the discretion of the investigator
- Pre-stroke mRS score of ≥ 3 (indicating functional dependence)
- Frank hypodensity in >1/3 of the affected arterial territory on non-contrast CT
- CT Perfusion ischemic core volume > 100 ml
- Known automated implantable cardiac defibrillator, pacemaker, cerebral aneurysm clip, cochlear implant, cranial neurostimulator or other device implant that is incompatible with the external magnetic field
- Known allergy or sensitivity to iron
- Known hemochromatosis, or known liver disease such as cirrhosis.
- Known aortic dissection
- Suspected septic embolization
- Contra indication to imaging with contrast agents
- Pregnant or lactating women
- Any terminal illness such that patient would not be expected to survive more than 6 months
- Current participation in another investigational drug or device treatment study
- Any condition that, in the judgment of the investigator could impose hazards to the patient if study therapy is initiated or affect the participation of the patient in the study.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Magnetically enhanced diffusion Magnetically enhanced diffusion Intra-arterial iron nanoparticles (4 x 1mg doses delivered every 3 minutes) delivered via microcatheter proximal to site of arterial occlusion(s) with external rotating magnet, total procedure 30min.
- Primary Outcome Measures
Name Time Method Proportion of participants with substantial reperfusion at final angiography (15 +/- 5min after final nanoparticle injection) without symptomatic intracranial hemorrhage on CT/MRI at 24h 24 hours +/- 6 hours * Substantial reperfusion is defined as \>50% reperfusion of the target occluded vessel territory at cerebral angiogram 15 (+/- 5) minutes after completion of the final nanoparticle injection. Target occluded vessel territory is defined based on the angiogram immediately prior to nanoparticle injection, as adjudicated by the core laboratory.
* Symptomatic intracranial hemorrhage is defined according to the Heidelberg Classification as new intracranial hemorrhage detected by brain imaging within 24h associated with any of the items below in the absence of an alternative explanation for clinical deterioration:
* ≥4 point increase in NIHSS at the time of diagnosis compared to the most recent NIHSS prior to worsening
* ≥2 point increase in one NIHSS category
* Leading to intubation/hemicraniectomy/external ventricular drain placement or other major medical/surgical intervention
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (7)
The Alfred Hospital
🇦🇺Melbourne, Victoria, Australia
Royal North Shore Hospital
🇦🇺St Leonards, New South Wales, Australia
John Hunter Hospital
🇦🇺Newcastle, New South Wales, Australia
The Austin Hospital
🇦🇺Melbourne, Victoria, Australia
Royal Adelaide Hospital
🇦🇺Adelaide, South Australia, Australia
The Royal Melbourne Hospital
🇦🇺Parkville, Victoria, Australia
Monash Medical Centre
🇦🇺Melbourne, Victoria, Australia