- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02169739
Remote Preconditioning Over Time To Empower Cerebral Tissue (REM-PROTECT)
Pilot, Randomized, Controlled, Staggered Start, Feasibility Trial of Ischemic Preconditioning, a Promising Novel Treatment for Stroke Prevention
Study Overview
Status
Intervention / Treatment
Detailed Description
In this study, the investigators will enroll 60 patients. All patients will receive best standard medical therapy for 2 years. In addition, the investigators will randomly assign 40 patients to undergo daily active remote ischemic preconditioning for 1 year, and 20 patients to 1 year of standard medical therapy followed by 1 year of daily active remote ischemic preconditioning. Patient structured interviews will be performed to assess if the treatment is well tolerated and easy for stroke patients to use. Magnetic resonance (MR) pictures of the brain will be used to determine if the active treatment stops the progression of brain injury. Cognitive tests and wireless sensor technology measures will used to learn what happens to the patient's brain and body during the active treatment.
After a subject consents to participate in the study, he/she will first participate in a study screening phase to ensure a basic level of tolerability of Remote Ischemic Conditioning (autoRIC™) device. The subject will undergo one full cycle of treatment under observation of the study team, including 4 cycles of alternating 5 minute inflation and 5 minute off periods
If the subject indicates willingness to continue receiving such treatment (screening success), she/she will enter the randomized trial phase, and be randomly allocated to the treatment or control group.
If subject indicates unwillingness to continue receiving such treatment (screening failure), he/she will not advance to the randomized phase of the trial. Screen failure subjects will be followed up with a 3-day post-device screening phone call to ensure safety and obtain information regarding any adverse events.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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California
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Los Angeles, California, United States, 90095
- University of California Los Angeles UCLA
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
I. Clinical
- Clinical lacunar stroke syndrome within the past 6 months
- Absence of signs or symptoms of cortical dysfunction
- No proximal large vessel atherosclerosis, intracranial atherosclerosis or cerebellar stroke.
- No major cardioembolic source requiring anticoagulation or other specific therapy
II. Imaging
Magnetic Resonance Imaging (MRI) presence of a small subcortical ischemic, any 1 or more of:
- Diffusion-weighted imaging (DWI) lesion < 2.0cm in size at largest dimension and corresponding to the clinical syndrome.
- Well delineated focal hyperintensity <2.0 cm in size at largest dimension (including rostro-caudal extent) on FLAIR or T2 and clearly corresponding to the clinical syndrome. If other focal hyperintensities are present, the case will be discussed with the principal investigator prior to randomization
- Multiple (at least 2) hypointense lesions of size 0.3-1.5 cm at largest dimension (including rostro-caudal extent) only in the cerebral hemispheres on FLAIR or T1 in patients whose qualifying event is clinically hemispheric
- Well delinated hypointense lesion <1.5 cm in size at the largest dimension (including rostro-caudal extent) on FLAIR or T1 corresponding to the clinical syndrome. MRI must be done at least 1 months after the qualifying stroke
- Absence of cortical stroke and large (> 1.5cm) subcortical stroke, recent or remote
- White matter hyperintensity score of 2 (moderate) or 3 (severe) on the European Scale of Age-Related White Matter Change
- Absence of cerebral amyloid antipathy (CAA) as per Boston Criteria.
Exclusion Criteria:
- Disabling stroke (Rankin Scale ≥4)
- Previous intracranial hemorrhage (excluding traumatic) or hemorrhagic stroke
- Age under 40 years
- High risk of bleeding (e.g. recurrent GI or GU bleeding, active peptic ulcer disease, etc.)
- Anticipated requirement for long term use of anticoagulants (e.g. recurrent deep venous thrombosis (DVT)
- Prior cortical or retinal stroke (diagnosed either clinically or by neuroimaging), or other prior cortical or retinal transient ischemic attack (TIA)
- Prior ipsilateral carotid endarterectomy
- Impaired renal function: estimated GFR <40
- Intolerance or contraindications to aspirin or clopidogrel (including thrombocytopenia, prolonged INR)
- Mini Mental Status Exam score < 24 (adjusted for age and education)
- Medical contraindication to MRI
- Pregnancy or women of child-bearing age who are not following an effective method of contraception
- Pre-existing neurologic, psychiatric, or advanced systemic disease that would confound the neurological or functional outcome evaluations
- SBP <90 or > 200
- Known history of limb vascular disease, limb vascular bypass surgery, or limb deep venous thrombosis
- Prisoners
- Homeless individuals
- Patient unable to give informed consent and no available legally authorized representative to provide informed consent
- Patient unlikely to be compliant with therapy/ unwilling to return for follow up visits
- Concurrent participation in another study with investigational drug or device treatment
- Other likely specific cause of stroke (e.g. dissection, vasculitis, prothrombotic diathesis, drug abuse)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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No Intervention: Medical therapy only
Intensive standard medical secondary prevention stroke treatment as per the recommendations of the American Heart Association/American Stroke Association national guidelines.
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Active Comparator: Ischemic Preconditioning + Medical
Patients will receive treatment with Cell Aegis remote ischemic preconditioning device once or twice daily for one year.
The procedure will consist of up to four 5-minute cycles of bilateral upper extremity ischemia separated by five minutes of reperfusion.
Patients will also receive intensive standard medical secondary prevention stroke treatment as per the American Heart Association/American Stroke Association national guidelines.
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Patients will undergo ischemic preconditioning once or twice daily for up to four 5-minutes cycles of bilateral upper extremity ischemia separated by 5-minute periods of reperfusion.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Duration of Adherence to Ischemic Preconditioning Procedure
Time Frame: 12 months
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12 months
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
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Limb Ischemia as Assessed by the Preconditioning Device
Time Frame: 12 months
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12 months
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Patient Self-reported Comfort-discomfort on a Scale of 1-5, With Lowest Score = "Very Comfortable" and 5 = "Very Uncomfortable"
Time Frame: 12 months
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12 months
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Latisha K Sharma, MD, University of California, Los Angeles
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Mental Disorders
- Pathologic Processes
- Cardiovascular Diseases
- Vascular Diseases
- Cerebrovascular Disorders
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Neurocognitive Disorders
- Cognition Disorders
- Stroke
- Ischemic Stroke
- Ischemia
- Cognitive Dysfunction
- Cerebral Small Vessel Diseases
Other Study ID Numbers
- AHA-000-376
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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