NCT06654375招募中不适用
Thrombectomy Versus Best Medical Management in Large Vessel Occlusion Stroke Patients Presenting Beyond 24 Hours and With Presence of Collateral Flow on CT Angiography: A Multicentre, Open-label, Registry-linked, Randomised Controlled Trial
Tianjin Huanhu Hospital1 个研究点 分布在 1 个国家目标入组 350 人开始时间: 2024年6月25日最近更新:
适应症
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 发起方
- 入组人数
- 350
- 试验地点
- 1
- 主要终点
- modified Rankin Scale
研究概览
简要总结
The goal of this clinical trial is to investigate if endovascular treatment (EVT) can effectively treat patients with large vessel occlusion (LVO) who present beyond the typical 24-hour window after symptom onset. The main questions it aims to answer are:
- Can EVT improve functional independence at 90 days for patients treated after 24 hours?
- What is the safety profile of EVT in this delayed treatment group compared to best medical management (BMM)? Researchers will compare EVT outcomes in patients presenting after 24 hours to those receiving BMM to see if EVT offers significant benefits.
Participants will:
- Receive either EVT or BMM based on their eligibility.
- Undergo CT angiography to assess collateral circulation and to confirm the presence of LVO.
- Be followed for 90 days to evaluate functional outcomes and safety measures.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Confirmation of ICA or MCA-M1 occlusion, as detected by MRA or CTA, with carotid occlusions potentially occurring in either the cervical or intracranial regions, and the possibility of accompanying tandem MCA lesions.
- •Demonstration of moderate to good collateral flow, as evidenced by CTA imaging.
- •The patient must be aged 18 years or older.
- •The baseline NIHSSS score is equal to or greater than 2, and this score remains equal to or greater than 2 immediately prior to randomization.
- •Endovascular treatment can be initiated (via femoral puncture) within a window of 24 to 72 hours from the onset of the stroke. The onset of the stroke is defined as the time the patient was last known to be at their neurologic baseline (patients with wake-up strokes are eligible if they meet the aforementioned time constraints).
- •There must be no significant pre-stroke disability, as indicated by a pre-baseline modified Rankin Scale score of 0-
- •The patient must be willing and able to return for the protocol-required follow-up visits.
- •The patient or their legally authorized representative must have signed the Informed Consent form.
排除标准
- •The subject has a serious, advanced, or terminal illness (as determined by the investigator) or a life expectancy of less than six months.
- •The subject has a pre-existing medical, neurological, or psychiatric disease that would interfere with neurological or functional evaluations, or is already participating in another drug or device study.
- •The subject is pregnant.
- •The subject has contraindications for both MRI and CT contrast that prevent an MRI or CT contrast perfusion study. The hospital's local standard criteria should be applied to determine if contraindications exist.
- •The subject has a known allergy to iodine and has previously been refractory to pretreatment medications.
- •The subject has been treated with tPA more than 4.5 hours after the last known well time.
- •The subject has a known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency, or has recently undergone oral anticoagulant therapy with an INR greater than
- •The subject has symptoms consistent with stroke in multiple locations.
- •The subject has seizures at stroke onset, which makes the diagnosis of stroke doubtful and precludes obtaining an accurate baseline NIHSS assessment.
- •The subject has a baseline blood glucose level of less than 50mg/dL (2.78 mmol) or greater than 400mg/dL (22.20 mmol).
- •The subject has a baseline platelet count of less than 50,000/uL.
- •The subject has severe, sustained hypertension (Systolic Blood Pressure >185 mmHg or Diastolic Blood Pressure >110 mmHg) that is not treatable with medications.
- •The subject is currently participating in another investigational drug or device study or registry.
- •The subject is presumed to have a septic embolus, suspicion of bacterial endocarditis, or cerebral vasculitis.
- •The subject has had clot retrieval attempted using a neurothrombectomy device within 24 hours of symptom onset.
结局指标
主要结局
modified Rankin Scale
时间窗: 90 days (± 14 days)
a 7-point scale ranging from 0 (no symptoms) to 6 (death)
次要结局
- dichotomized mRS score of of 0-2 vs 3-6(at 90 days)
- dichotomized mRS score of 0-3 vs 4-6(at 90 days)
- death(at 90 days)
- Score on the Barthel Index(at 90 days)
- Score on the EQ-5D-5L(at 90 days)
- extended treatment in cerebral ischemia (eTICI) score(during EVT procedure)
- recanalization rate(24 hours after randomization, assessed using Computed Tomography Angiography (CTA) or Magnetic Resonance Angiography (MRA))
- score on the NIHSS(24 hours after randomization, 5 to 7 days after randomization, or at discharge, whichever occurs first)
- final infarct volume on MRI(24 hours after randomization on MRI)
- dichotomized mRS score of 0-1 vs 2-6(at 90 days)
研究者
Ming Wei
Chief Physician
Tianjin Huanhu Hospital
研究点 (1)
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