Robot-Assisted Hematoma Evacuation With Intrahematoma Tenecteplase for Post-Reperfusion PH2 Hemorrhagic Transformation (REPORT)

June 6, 2026 updated by: Kaijiang Kang, Beijing Tiantan Hospital

A Phase I, Open-Label, Single-Arm Study of Robot-Assisted Stereotactic Minimally Invasive Hematoma Aspiration Followed by Intrahematoma Tenecteplase in Patients With Symptomatic Supratentorial PH2 Hemorrhagic Transformation After Reperfusion Therapy for Acute Ischemic Stroke

The purpose of this phase I trial is to evaluate the safety and feasibility of robot-assisted stereotactic minimally invasive hematoma aspiration, followed when eligible by intrahematoma tenecteplase administration, in patients who develop symptomatic supratentorial PH2 hemorrhagic transformation after reperfusion therapy for acute ischemic stroke. The main study questions are whether this strategy is associated with an acceptable early rebleeding risk and whether it can achieve clinically meaningful hematoma reduction with accurate catheter placement and relief of hematoma-related mass effect.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Symptomatic intracranial hemorrhage after reperfusion therapy is one of the most devastating complications of acute ischemic stroke and is associated with high mortality, especially in patients with PH2 hemorrhagic transformation and substantial mass effect. Current management is largely supportive and includes discontinuation of antithrombotic agents, correction of coagulation abnormalities, blood pressure control, and intracranial pressure management. However, medical treatment does not remove the hematoma or reverse the local toxic and space-occupying effects of blood products.

Open craniotomy may be lifesaving in selected patients, but it may also cause additional injury to already ischemic and vulnerable brain tissue. Robot-assisted stereotactic minimally invasive puncture and aspiration may provide a less disruptive method to evacuate hematoma, reduce mass effect, and preserve surrounding tissue. A prior phase I neuronavigation-assisted minimally invasive puncture study in spontaneous deep intracerebral hemorrhage identified 0.009 mg/mL of hematoma-volume-adjusted tenecteplase as the highest tested dose with acceptable safety and the greatest mean hematoma clearance. Because the present trial targets a different and higher-risk population, namely post-reperfusion therapy PH2 hemorrhagic transformation, the study remains phase I in intent but uses a fixed dose rather than a dose-escalation design.

This is a prospective, open-label, single-arm phase I trial enrolling 20 participants with symptomatic supratentorial PH2 hemorrhagic transformation after reperfusion therapy (intravenous thrombolysis, with or without bridging mechanical thrombectomy). Eligible hematomas may be deep or lobar and must be associated with clinically relevant neurological worsening and hematoma-related mass effect. Before puncture, all participants must undergo protocol-based correction of coagulation abnormalities and at least one stability CT scan confirming no ongoing rapid expansion. Robot-assisted stereotactic aspiration and catheter placement will then be performed. A repeat CT approximately 2 hours later must confirm no procedure-related rebleeding before intrahematoma tenecteplase is started.

Tenecteplase will be administered once daily through the indwelling catheter at a fixed dose of 0.009 mg/mL of residual hematoma volume, for up to 3 doses. Each dose will be diluted to 1 mL with sterile water for injection, followed by a 3 ml normal saline flush. The catheter will remain clamped for 2 hours and then reopened for drainage. Treatment will stop when any termination criterion is met, including symptomatic rebleeding, radiographic hematoma enlargement, residual hematoma of 10 mL or less, or completion of 3 doses.

The primary objective is safety, particularly symptomatic rebleeding within 72 hours after the procedure or first tenecteplase dose, defined as clinically relevant hematoma expansion at the original cavity or catheter tract accompanied by neurological deterioration. The main efficacy and feasibility objectives are to determine whether the procedure achieves protocol-defined hematoma reduction-residual hematoma volume<15 mL or <33% of baseline volume by end-of-treatment CT-and accurate catheter placement within 3 mm of the planned target on immediate postoperative imaging. Secondary outcomes include residual hematoma volume at Day 7 or end of treatment, the proportion of participants achieving residual hematoma ≤10 mL, any radiographic rebleeding through Day 7, and procedure-related serious adverse events（SAE） through Day 7.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
20

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Phase 1

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Locations

  • China
    • Beijing Municipality
      • Beijing, Beijing Municipality, China, 100070
        • Beijing Tiantan Hospital, Capital Medical University
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

•. Age 18 years or older and younger than 80 years.

  • Prestroke modified Rankin Scale score of 0 to 2.
  • Acute ischemic stroke treated with reperfusion therapy (standard-dose intravenous thrombolysis using alteplase or tenecteplase, or mechanical thrombectomy or any other endovascular reperfusion procedure for the index stroke).
  • CT-confirmed symptomatic PH2 hemorrhagic transformation according to ECASS criteria in a supratentorial deep or lobar location, with hematoma-related mass effect and/or midline shift.
  • Hematoma volume 20 to 80 mL measured by ABC/2 method.
  • Neurological deterioration attributed to hemorrhagic transformation, defined as an NIHSS increase of 4 points or more from the best post-thrombolysis status or a GCS decrease of 2 points or more.
  • At least one repeat stability CT scan obtained 6 hours or more after the diagnostic CT showing no ongoing rapid expansion, defined as hematoma growth less than 6 mL.
  • Planned robot-assisted stereotactic minimally invasive puncture/aspiration within 24 hours after the diagnostic CT.
  • Completion of intravenous thrombolytic infusion at least 4 hours before final preprocedure assessment, with protocol-based reversal/correction of coagulopathy as needed.
  • Preprocedure coagulation thresholds achieved after reversal/correction: INR < 1.4 or less, and fibrinogen > 1.6 g/L.
  • Systolic blood pressure 180 mmHg or less maintained for at least 6 hours before the procedure.
  • Written informed consent provided by the participant or legally authorized representative.

Exclusion Criteria:

  • HI1, HI2, or PH1 hemorrhagic transformation without clinically relevant mass effect.
  • Infratentorial hemorrhage, including brainstem or cerebellar hemorrhage.
  • Large malignant hemispheric infarction in which the dominant cause of mass effect is ischemic edema rather than hematoma, or clear need for decompressive craniectomy as first-line treatment.
  • Hemorrhage primarily attributable to aneurysm, arteriovenous malformation, dural arteriovenous fistula, moyamoya disease, tumor, trauma, or another structural lesion; or hemorrhage caused predominantly by a procedural vascular injury unrelated to thrombolysis-associated hemorrhagic transformation.
  • Intraventricular hemorrhage requiring separate emergency surgical treatment as the dominant lesion.
  • Irreversible brainstem failure, bilateral fixed and dilated pupils, or GCS score of 4 or less.
  • Ongoing hematoma expansion on stability CT, defined as growth of 6 mL or more.
  • Imaging evidence of active bleeding or markedly high rebleeding risk, such as spot sign, if judged unsafe for catheter aspiration.
  • Need for long-term anticoagulation that cannot be safely interrupted during the first 30 days after treatment.
  • No safe robot-planned stereotactic trajectory to the hematoma cavity.
  • Severe hepatic, renal, cardiac, respiratory, or hematologic illness likely to confound assessment or markedly increase procedural risk.
  • Pregnancy or breastfeeding.
  • Known allergy or hypersensitivity to alteplase or tenecteplase.
  • Participation in another interventional clinical trial.
  • Any other condition that, in the investigator's judgment, makes the participant unsuitable for this study.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Robot-assisted stereotactic hematoma aspiration plus intrahematoma tenecteplase

Participants will undergo robot-assisted stereotactic minimally invasive puncture/aspiration with indwelling catheter drainage. After a postoperative stability CT confirms no rebleeding, intrahematoma tenecteplase will be administered through the catheter.

Procedure: Robot-assisted stereotactic minimally invasive hematoma aspiration and drainage. Using fused CT and/or MRI images, a robot-guided trajectory will be planned to avoid major vessels, eloquent cortex, and vulnerable peri-infarct tissue when feasible. Initial evacuation will be performed with passive drainage or very low-pressure aspiration, avoiding rapid decompression. Catheter position will be confirmed on postoperative CT.
Drug: Robot-assisted stereotactic hematoma aspiration plus intrahematoma tenecteplase

Procedure: Robot-assisted stereotactic minimally invasive hematoma aspiration and drainage. Using fused CT and/or MRI images, a robot-guided trajectory will be planned to avoid major vessels, eloquent cortex, and vulnerable peri-infarct tissue when feasible. Initial evacuation will be performed with passive drainage or very low-pressure aspiration, avoiding rapid decompression. Catheter position will be confirmed on postoperative CT.

Drug: Tenecteplase (TNK) for intrahematoma administration. After a 2-hour postoperative stability CT confirms no rebleeding, the dose will be calculated as residual hematoma volume × 0.009 mg/mL, diluted to 1 mL with sterile water for injection, instilled through the indwelling catheter, and followed by a 3mL normal saline flush. The catheter will be clamped for 2 hours and then reopened for gravity drainage. TNK will be given once every 24 hours for up to 3 doses.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Symptomatic rebleeding rate
Time Frame: Through 72 hours after procedure or first TNK dose
Symptomatic rebleeding is defined as an increase in hematoma volume of more than 6 mL or more than 33% compared with the immediate postoperative CT or the previous study CT, occurring at the original hematoma cavity or catheter tract, together with neurological worsening defined as an NIHSS increase of 4 points or more or a GCS decrease of 2 points or more.
Through 72 hours after procedure or first TNK dose
Target hematoma reduction rate
Time Frame: End of treatment, defined as within 7 days after procedure or before catheter removal
Proportion of participants with residual hematoma volume less than 15 mL or less than 33% of baseline hematoma volume on the end-of-treatment CT scan.
End of treatment, defined as within 7 days after procedure or before catheter removal
Technical success of catheter placement
Time Frame: Immediate postoperative CT, within 24 hours after procedure
Successful placement of the catheter tip within 3 mm of the planned target on postoperative imaging.
Immediate postoperative CT, within 24 hours after procedure

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Residual hematoma volume
Time Frame: Day 7, or at end of treatment
Residual hematoma volume measured by CT using ABC/2 or a prespecified volumetric method.
Day 7, or at end of treatment
Proportion achieving residual hematoma ≤10 mL
Time Frame: Day 7, or at end of treatment
Participants meeting the treatment-completion target for catheter removal or treatment termination.
Day 7, or at end of treatment
Any radiographic rebleeding
Time Frame: Through Day 7
Any increase in hematoma volume meeting protocol imaging criteria regardless of clinical symptoms.
Through Day 7
Procedure-related SAES
Time Frame: Through Day 7
Procedure-related SAES
Through Day 7

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Beijing Tiantan Hospital

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Kaijiang Kang, MD, Beijing Tiantan Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

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Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
June 10, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 10, 2026

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 30, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
June 6, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 6, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
June 11, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
June 11, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 6, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
June 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • KY2024-386-02

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Individual participant data that underlie the results reported in this article, after de-identification.

IPD Sharing Time Frame

Beginning 3 months and ending 5 years following article publication.

IPD Sharing Access Criteria

Researchers with a peer-reviewed biological research proposal. Please contact the PI via email （kangkaijiang678@126.com）to request data access.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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