Tenecteplase vs Medical Management in 4.5-24h Anterior Circulation Large Vessel Occlusion With no Access to EVT
试验速览
- 阶段
- 3 期
- 状态
- 尚未招募
- 发起方
- 入组人数
- 794
- 试验地点
- 1
- 主要终点
- Proportion of patients with functional independence outcome (mRS 0-2) at day 90
研究概览
简要总结
The goal of this clinical trial is to learn if tenectplase works to acute ischemic stroke (AIS) with onset 4.5-9 hours. It will also learn about the safety of tenectplase in AIS with onset 4.5-9 hours. The main question it aims to answer is: Does tenectplase improve the 90-days functional outcome in participants with acute large vessel occlusion? Researchers will compare tenectplase thrombolysis to non-use to see if tenectplase works to improve the functional outcome in participants with onset 4.5-9 hours. Participants will:* Receive 0.25mg/kg (max 25mg) tenectplase at admission (after randomization) .* Receive neurological assessment at admission, Day 5-7 or on hospital discharge (whichever earlier). Audio or video of the assessment may be recorded if possible.* Receive brain CT + CT angiogram + CT perfusion and MRI after randomization, where the CT scan may be repetitive.
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
- Single (Outcomes Assessor)
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
- •Age 18 years or greater
- •Acute ischemic stroke presenting in the 4.5 to 24 hour window from last seen well (including wake-up stroke and no witness stroke).
- •Prestroke mRS 0-2
- •NIHSS 6 to 25
- •Aspect ≥ 7
- •ICA terminus, M1, dominant M2 occlusion on CTA or MRA
- •Clinical-imaging mismatch assessed by investigator
- •Patients with no access to EVT at the time of randomization
排除标准
- •Current or past history of significant bleeding over the past 6 months;
- •History of intracranial hemorrhage (including possible subarachnoid hemorrhage or subarachnoid hemorrhage due to an aneurysm) or evidence or suspected intracranial hemorrhage;
- •Known bleeding tendency;
- •Recent severe or dangerous bleeding, or active ulcerative gastrointestinal disease;
- •History of central nervous system injury (e.g., intracranial tumor, aneurysm, or arteriovenous malformation, intracranial or spinal surgery), or recent head injury；
- •Tumors that increase risk of bleeding;
- •Severe liver dysfunction, including liver failure, cirrhosis, portal hypertension (esophageal varices), and active hepatitis;
- •Know arterial / venous malformation or aneurysm;
- •Bacterial endocarditis, pericarditis, or acute pancreatitis;
- •Patients receiving effective anticoagulant therapy (vitamin K antagonists with INR > 1.3, or other oral anticoagulants exceeding the upper limit of the corresponding standard range);
- •Heparin use within the past 48 hours and prothrombin time exceeding the upper limit of the standard range;
- •Over the past 3 months, undergone major surgery, organ biopsy, or suffered a serious injury;
- •Over the past 2 weeks, receiving prolonged ( >2 minutes) cardiopulmonary resuscitation, childbirth, or non-stressful vascular puncture (such as subclavian or jugular vein puncture);
- •Stroke episode occurred with epileptic seizure;
- •History of stroke comorbid with diabetes;
- •History of stroke over the past 3 months；
- •Acute bleeding tendency, including platelet count below 100×10⁹/L or other conditions;
- •SBP >185 mmHg or DBP >110 mmHg, or requiring intensive treatment (intravenous antihypertensive drugs) to lower blood pressure to within limits;
- •Blood glucose <2.8 mmol/L or >22.2 mmol/L (<50 mg/dL or >400 mg/dL)；
- •Patient life expectancy of less than 1 year;
- •Simultaneous occlusion of multiple blood vessels, defined as bilateral MCAs or MCAs combined with the basilar artery;
- •Pregnant women or nursing mothers；
- •Patients with a low likelihood of 3-month follow-up；
- •Over the past 3 months participated in other interventional clinical trials.
研究组 & 干预措施
TNK
Participants will receive intravenous tenecteplase at a dose of 0.25 mg/kg (max 25 mg) administered as a bolus after enrollment. Subsequent treatment will be administered with antiplatelet drugs, anticoagulation or combinations of these treatment modality according to national and institutional guidelines.
干预措施: TNK (Drug)
Standard medical management
Participants will receive antiplatelet drugs, anticoagulation or combinations of these treatment modality according to national and institutional guidelines.
干预措施: Standard medical treatment (Drug)
结局指标
主要结局
Proportion of patients with functional independence outcome (mRS 0-2) at day 90
时间窗: 90 days after procedure
modified Rankin scale (range, 0 to 6, with a score of 0 indicating no disability, 1 no clinically significant disability, 2 slight disability, 3 moderate disability but remaining able to walk unassisted, 4 moderately severe disability, 5 severe disability, and 6 death)
次要结局
- The ordinal shift of modified Rankin Scale(90 days after procedure)
- Proportion of patients with functional independence outcome (mRS 0-1) at day 90(90 days after procedure)
- Recanalization of occlusion site according to the arterial occlusive lesion (AOL) scale(24 hours after randomization)
- Change in Neurological Function of Participants Assessed by National Institute of Health Stroke Scale(Baseline and 7-days after randomization (or at discharge))
- Symptomatic intracranial hemorrhage (SICH) as defined by the Heidelberg Bleeding Classification(within 36 hours after randomization)
研究者
Wei Hu
Professor
The First Affiliated Hospital of University of Science and Technology of China