Superselective Citicoline and Verapamil for Ischemic Neuroprotection and Greater Effective Response (SCAVINGER)

September 21, 2016 updated by: Justin Fraser

Superselective Citicoline And Verapamil for Ischemic Neuroprotection and Greater Effective Response (SCAVINGER) in the Kentucky Regional Population: A Clinical and Translational Study

This is a phase 1, blinded-outcome, randomized, placebo controlled study to investigate the safety and feasibility of super-selective intra-arterial administration of verapamil and citicoline immediately following successful endovascular thrombectomy as a potential neuroprotective synergistic therapeutic strategy in emergent large vessel occlusion stroke. This trial represents the first time that citicoline will be evaluated in human subjects as a superselectively administered neuroprotective agent administered in an acute time frame as an adjunct to intra-arterial thrombectomy. Furthermore, it will represent the first trial to evaluate combinational therapy for acute stroke neuroprotection.

Study Overview

Status

Withdrawn

Conditions

Intervention / Treatment

Detailed Description

Participants will be recruited from patients evaluated at University of Kentucky Chandler Hospital for acute ischemic stroke. Participants with impaired capacity may be included, as the pathology to be studied (stroke) may impair their capacity. Initial contact will be made by the sub-investigators approved to obtain consent; all sub-investigators are practitioners who would make contact with potential participants in a clinical manner under standard clinical procedures. All sub-investigators will have access to stroke patients' medical information under normal circumstances. No special outreach is necessary to recruit particular populations. Enrollment goal will be 15 patients in each group.

Participants will not be compensated or provided any incentives for study participation.

The following describes all study procedures and evaluations that are to be done as part of the study.

Visit 1-Baseline (Day 0):

  • Obtain consent.
  • Medical history taken from medical record, participant and family to determine eligibility based on inclusion/exclusion criteria (Standard of Care)
  • Medication history (Standard of Care)
  • Physical examination to include vital signs (Standard of Care)
  • Pregnancy Testing (Standard of Care)
  • NIH Stroke Scale (Standard of Care)
  • Verify inclusion/exclusion criteria
  • Randomization
  • Cerebral angiogram with Endovascular Thrombectomy (Standard of Care)
  • Study Drug administration
  • Adverse event (AE) collection

Visit 2 - Within 48 hours of admission

• Non-contrast Postoperative MRI or CT (Standard of Care) The choice of one or the other will be determined by clinical criteria; CT or MRI may be preferable for different reasons depending upon the patient's clinical scenario.

Visit 3 - ( By Discharge)

  • NIH Stroke Scale (Standard of Care)
  • Discharge Destination (Standard of Care)
  • Cognitive Assessment (Standard of Care)
  • Radiographic assessment of primary and secondary radiologic endpoints

Visit 4 - End of Study (90 Days) (+/- 30 days)

  • UBACC assessment will be used to assess consent capacity at follow-up.
  • Montreal Cognitive Assessment (MoCA)
  • Modified Rankin Score (mRS; Standard of Care)

The visit may be conducted over the phone with the participant or their legally authorized representative.

Unscheduled Visits. It is unexpected that Unscheduled Visits will be common, especially with the follow-up within 90 days after the procedure. However, subjects readmitted to the hospital for any reason will be tracked to determine if an AE occurred.

There are no particular prohibited medications, treatments, or procedures for after administration of the study drug. However, therapeutic anticoagulation is a relative contraindication to thrombectomy. Patients on therapeutic anticoagulation will be excluded from the study.

Following successful completion of the baseline visit, participants will be randomized into the study. The randomization number will be assigned by the PI/neurointerventionalist.

Participants will be randomized to receive 10mg of verapamil in 10 cc of normal saline and 1000mg of citicoline in 10cc of normal saline or matching placebo.

Study Type

Interventional

Phase

  • 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 Locations

  • United States
    • Kentucky
      • Lexington, Kentucky, United States, 40536
        • University of Kentucky Medical Center

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

Ages Eligible for Study

18 years to 101 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Signed and dated informed consent and HIPAA form. Participants with impaired capacity may be included provided a Legally Authorized Representative as recognized by the the State of Kentucky, signs the informed consent.
  • Willingness to comply with all study procedures and availability for the duration of the study.
  • Male or female, aged 18 years or older
  • Suspected acute ischemic stroke based on clinical and radiographic evidence as determined and documented by the Stroke Neurology team at University of Kentucky.
  • Participants must meet criteria for intra-arterial thrombectomy as determined and documented by Interventional Neuroradiology attending physician at University of Kentucky.
  • Participants must have an acute thromboembolus within an intracranial artery in the anterior circulation (internal carotid, anterior cerebral, middle cerebral), which undergoes mechanical thrombectomy.
  • Participant must have a TICI 2B or better revascularization via thrombectomy.
  • For females of reproductive potential a negative pregnancy test at baseline is required. .

Exclusion Criteria:

  • Pregnant/lactating women
  • Therapeutic anticoagulation prior to admission as it is a relative contraindication to thrombectomy
  • Participants who undergo intra-arterial thrombectomy for acute stroke, in whom only TICI 0-2A revascularization is obtained.
  • Known allergic reactions to components of Verapamil or Citicoline.
  • Verapamil should not be given to individuals who have a serious heart condition such as:
  • sick sinus syndrome or AV block
  • severe heart failure;
  • fainting do to slow heartbeats
  • certain heart rhythm disorders of the atrium (excluding atrial fibrillation)
  • active congestive heart failure;
  • low blood pressure;
  • a nerve-muscle disorder such as myasthenia gravis or muscular dystrophy.

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: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Verapamil and Citicoline
10mg of verapamil in 10 cc of normal saline and 1000mg of citicoline in 10cc of normal saline will be administered over 20 minutes (1cc/minute) through the microcatheter and into the vessel previously obstructed by clot to the treatment group
Drug: Verapamil and Citicoline
Single dosing strategy will be used.
Other Names:
  • CDP-choline
Placebo Comparator: Placebo
The control group will receive saline only.
Other: Placebo
Single matching dosing strategy will be used.
Other Names:
  • 0.9% sodium chloride

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of participants having no symptomatic intracranial hemorrhage
Time Frame: within 48 hours after treatment
Defined as a hemorrhage occurring within 48 hours after study inclusion, temporally related to the intervention, and occurring with worsening neurological status as documented in the clinical exam.
within 48 hours after treatment

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of participants who had no systemic side effects from verapamil and citicoline administration.
Time Frame: within 90 days
At any point during study treatment
within 90 days

Collaborators and Investigators

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

Sponsor

Justin Fraser

Investigators

  • Principal Investigator: Justin Fraswer, MD, University of Kentucky

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

August 1, 2016

Primary Completion (Actual)

September 1, 2016

Study Completion (Actual)

September 1, 2016

Study Registration Dates

First Submitted

June 24, 2016

First Submitted That Met QC Criteria

July 5, 2016

First Posted (Estimate)

July 6, 2016

Study Record Updates

Last Update Posted (Estimate)

September 23, 2016

Last Update Submitted That Met QC Criteria

September 21, 2016

Last Verified

September 1, 2016

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Citicoline and Verapamil

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

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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