Comparison Influence to Prognosis of CTP and MRP in AIS Patients

November 21, 2022 updated by: Second Affiliated Hospital, School of Medicine, Zhejiang University

Comparison Influence to Prognosis of Computed Tomography Perfusion (CTP) and Magnetic Resonance Perfusion (MRP) in Acute Ischemic Stroke (AIS) Patients

Acute ischemia stroke (AIS) is the leading cause of death in China. Thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) has been proven to reduce disability in AIS patients within 4.5 hours after symptom onset. However, only 2% of AIS patients received thrombolytic therapy in China.

Perfusion imaging is demonstrated to increase the rate of thrombolytic therapy by identifying the ischemic infarct core (the brain tissue that is irreversibly injured) and the ischemia penumbra (the brain tissue surrounding the ischemia infarct core that is hypoperfused but still viable) for those patients with extending therapeutic window (beyond the current 4.5 hours after symptom onset), as well as minor stroke or those with atypical symptoms.

Three prospective clinical trials, DEFUSE, DEFUSE-2 and EPITHET, has confirmed that mismatch between perfusion weighted-imaging (PWI) and diffusion weighted-imaging (DWI) correspond to the ischemic penumbra whereas DWI provides information of the ischemia infarct core and major reperfusion relate to good clinical outcome in extending therapeutic window AIS patients with DWI-PWI mismatch.

Computed tomography perfusion (CTP) may be a potential alternative technology for recognition of reversibly damaged brain tissue in AIS patients, with the prominent advantage of fast scan. Recent studies also demonstrated that CTP could select eligible candidates for reperfusion therapy. More recently, with data of EXTEND-IA, reperfusion therapy in AIS patients with CTP mismatch (using a CT time to maximum >6 s as ischemic hypoperfusion volume and a CT relative cerebral blood flow <30% of that in normal tissue as ischemic core volume) were related to good clinical outcome.

However, plenty of studies demonstrated CT cerebral blood volume did not always predict ischemic infarct core in AIS patients. A recent study also confirmed the poor contrast: noise ratios of CT cerebral blood volume and CT cerebral blood flow result in large measurement error, compared with those of diffusion weighted imaging (DWI), making it problematic to substitute DWI in selecting individual AIS patients for reperfusion treatment.

Based on those studies, it is still remained unclear whether CTP can be an alternative choice to replace magnetic resonance perfusion (MRP) in AIS patients with extending therapeutic windows. So in this study, the investigators try to determine whether baseline CTP profiles have a comparable ability to MRP in identifying patients who have a robust clinical response after early reperfusion.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

This is a prospective, non-blind, single-center clinical trial to evaluate whether baseline computed tomography perfusion (CTP) profiles have a comparable ability to magnetic resonance perfusion (MRP) in identifying acute ischemia stroke (AIS) patients who have a robust clinical response after early reperfusion.

The study will enroll 1000 patients, and patients will be divided into 2 groups according to the imaging available situation (to see which can provide immediately): CTP scan group and MRP scan group.

Core: CT: cerebral blood flow <30% of that in normal tissue / MR: ADC < 600 ×D10-6 mm2 / s.

Hypoperfusion: CT / MR: time to maximum >6.

For patients accepting CTP or MRP over 4.5 hours after stroke onset, only patients who meet imaging criteria (infarct core volume < 70mL, perfusion lesion volume / infarct core volume >1.2, and absolute mismatch >10 mL) at baseline will receive recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis. CTP or MRP will be performed at 24 hours after thrombolytic therapy. Modified Rankin score (mRS) will be measured at 3 months after stroke onset.

Study Endpoints: Primary endpoint: mRS 0-2 at 3 months. Secondary endpoints: (1) symptomatic intracranial haemorrhage, (2) reperfusion, (3) recanalization, and (4) infarct growth at 24 hours.

Criteria:

Inclusion Criteria:

  1. Provision of informed consent;
  2. Male and female adults aged 18-80 years old;
  3. For patients accepting CTP or MRP over 4.5 hours after stroke onset, imaging criteria: infarct core volume <70mL, perfusion leison volume / infarct core volume >1.2, and absolute mismatch >10 mL.

Exclusion Criteria:

  1. Standard contraindications to rt-PA;
  2. Contraindication to imaging with contrast agents;
  3. Pre-stroke mRS score of ≥2 (indicating previous disability);
  4. Participation in any investigational study in the previous 30 days;
  5. Any terminal illness such that patient would not be expected to survive more than one-year.

Study Type

Observational

Enrollment (Anticipated)

1000

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

  • China
      • Hangzhou, China, 310000
        • Recruiting
        • The Second Affiliated Hospital of Zhejiang University

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

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Probability Sample

Study Population

acute ischemic stroke patients

Description

Criteria:

Inclusion Criteria:

  1. Provision of informed consent;
  2. Male and female adults aged 18-80 years old;
  3. For patients accepting CTP or MRP over 4.5 hours after stroke onset, imaging criteria: infarct core volume <70mL, perfusion leison volume / infarct core volume >1.2, and absolute mismatch >10 mL.

Exclusion Criteria:

  1. Standard contraindications to rt-PA;
  2. Contraindication to imaging with contrast agents;
  3. Pre-stroke mRS score of ≥2 (indicating previous disability);
  4. Participation in any investigational study in the previous 30 days;
  5. Any terminal illness such that patient would not be expected to survive more than one-year.

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

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Computed Tomography Perfusion (CTP)
Other: inspection mode
different inspection modes：Computed Tomography Perfusion (CTP) or Magnetic Resonance Perfusion (MRP)
Magnetic Resonance Perfusion (MRP)
Other: inspection mode
different inspection modes：Computed Tomography Perfusion (CTP) or Magnetic Resonance Perfusion (MRP)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
modified Rankin Scale at 90 days
Time Frame: 90 days
modified Rankin Scale at 90 days
90 days

Collaborators and Investigators

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

Sponsor

Second Affiliated Hospital, School of Medicine, Zhejiang University

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

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 (Actual)

June 30, 2009

Primary Completion (Anticipated)

June 30, 2024

Study Completion (Anticipated)

December 30, 2026

Study Registration Dates

First Submitted

October 5, 2017

First Submitted That Met QC Criteria

December 4, 2017

First Posted (Actual)

December 8, 2017

Study Record Updates

Last Update Posted (Actual)

November 23, 2022

Last Update Submitted That Met QC Criteria

November 21, 2022

Last Verified

November 1, 2022

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CIPPIS

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

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.

Clinical Trials on Stroke

Clinical Trials on inspection mode

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Senegal

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

3
Subscribe