- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04065113
Middle Meningeal Artery Embolization for Chronic Subdural Hematoma
Middle Meningeal Artery (MMA) Embolization for Patients With Chronic Subdural Hematoma (cSDH)
Study Overview
Status
Conditions
Detailed Description
This study seeks to assess the safety and efficacy of middle meningeal artery embolization for chronic subdural hematoma in addition to standard treatments, which include close observation and surgical evacuation. Middle meningeal artery embolization has emerged recently as a minimally invasive and successful method of preventing re-accumulation of subdural hematoma, particularly for patients that are not obvious surgical candidates or those with recurrent or refractory hematomas. The outcomes of these two groups of patients who undergo middle meningeal artery embolization will be compared to matched historical controls.
Middle meningeal artery embolization is a minimally invasive angiography procedure completed with use of fluoroscopy. Access is obtained through the femoral or radial artery and a catheter is advanced to the MMA. Polyvinyl alcohol particles are then injected to seal off this portion of the artery and prevent any further blood flow into the subdural hematoma. Hemostasis is obtained at the access site and the patient is observed for 24-48 hours on a neurological care unit before discharge.
A head CT, NIHSS, and modified Rankin Score will be repeated on the following schedule: • Pre-Procedure
- 24 hours post procedure
- 7-10 days post procedure
- 30 days post procedure
- 90 days post procedure
Patients with chronic subdural hematoma undergo CT scans and neurologic assessments on hospital admission, as well as follow up CT scans and neurologic assessments to assess for any change in neurologic status or hematoma size. This study utilizes a standard of care follow up schedule to avoid exposing participants to extra radiation. Participants will be followed for study related purposes for 90 days.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Missouri
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Saint Louis, Missouri, United States, 63108
- Recruiting
- Washington University School of Medicine
-
Contact:
- Brigette Vaughn, BA
- Phone Number: 314-273-0368
- Email: b.vaughn@wustl.edu
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Principal Investigator:
- Joshua W Osbun, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients 18 years or older undergoing treatment for a new diagnosis of chronic subdural hematoma (cSDH) or
- Patients 18 year or older who have undergone surgical evacuation of a subdural hematoma and have a significant residual hematoma status post-surgery or who develop a recurrent subdural hematoma.
and
- Minimal symptoms such as headache, altered mental status, or mild neurological deficit only
- Ability to understand and sign written informed consent by patient or LAR
Exclusion Criteria:
- Significant midline shift and/or neurologic symptoms requiring urgent decompression.
- Common carotid stenosis of over 50%.
- Significant contraindication to angiography (eg. kidney failure, difficult anatomy).
- SDH related to underlying condition
- Acute SDH
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Embolization Only
Medically managed patient receives middle meningeal artery embolization
|
Seal off blood supply to the middle meningeal artery to prevent growth of subdural hematoma
Other Names:
|
Experimental: Embolization + Evacuation
Participant receives standard of care evacuation and then undergoes MMA embolization
|
Seal off blood supply to the middle meningeal artery to prevent growth of subdural hematoma
Other Names:
Drainage of subdural hematoma via burrhole or craniotomy
Other Names:
|
No Intervention: Medical Management
Historical control of medically managed patients
|
|
Active Comparator: Surgical Patients
Historical control of patients receiving standard surgery alone
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Drainage of subdural hematoma via burrhole or craniotomy
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of patients with recurrent or refractory hematoma (Radiographic resolution)
Time Frame: A head CT will be repeated 24 hours after the procedure, 7-10 days, 30 days, and 90 days post procedure to measure any change in size of the SDH compared to pre-procedure size
|
The subdural hematoma persists or reoccurs
|
A head CT will be repeated 24 hours after the procedure, 7-10 days, 30 days, and 90 days post procedure to measure any change in size of the SDH compared to pre-procedure size
|
Number of patients requiring secondary evacuation surgery (Treatment Efficacy)
Time Frame: Evacuation surgery required within the 90 day follow up period
|
The participant requires a post-procedure (post-MMA embolization) evacuation of the subdural hematoma due to re-occurrence or persistence of hematoma and symptoms
|
Evacuation surgery required within the 90 day follow up period
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Procedure-related complication rate (Safety)
Time Frame: Procedure-related complications will be compared between embolization and historical surgical patients assessed through study completion, 90 days
|
Complication rate of embolization procedure vs surgery
|
Procedure-related complications will be compared between embolization and historical surgical patients assessed through study completion, 90 days
|
Change in NIH Stroke Scale Score (Functional outcome)
Time Frame: Compared pre-procedure, 24 hours post-procedure, 7-10 days, 30 days, and 90 days post-procedure
|
Change in score on National Institutes of Health Stroke Scale. The NIH Stroke Scale is used to quantify neurologic impairments. It consists of 11 items each scored between 0 and 4 points. The maximum score is 42, indicating severe impairment, and the minimum score is 0. Stroke severity 0 No stroke symptoms 1-4 Minor stroke 5-15 Moderate stroke 16-20 Moderate to severe stroke 21-42 Severe stroke |
Compared pre-procedure, 24 hours post-procedure, 7-10 days, 30 days, and 90 days post-procedure
|
Change in modified Rankin Scale (Functional outcome)
Time Frame: Compared pre-procedure, 24 hours post-procedure, 7-10 days, 30 days, and 90 days post-procedure
|
Change in score on modified Rankin Scale The modified Rankin Scale (mRS) measures the degree of disability or dependence after a stroke or other neurologic disease. The scale runs from 0-6, with 0 indicating perfect health with no symptoms to 6 indicating death. 0 - No symptoms.
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Compared pre-procedure, 24 hours post-procedure, 7-10 days, 30 days, and 90 days post-procedure
|
Change in size of subdural hematoma
Time Frame: Compared pre-procedure, 24 hours post-procedure, 7-10 days, 30 days, and 90 days post-procedure
|
CT scan measurements of size of subdural hematoma
|
Compared pre-procedure, 24 hours post-procedure, 7-10 days, 30 days, and 90 days post-procedure
|
Collaborators and Investigators
Investigators
- Principal Investigator: Joshua W Osbun, MD, Washington University School of Medicine
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Pathologic Processes
- Cardiovascular Diseases
- Vascular Diseases
- Cerebrovascular Disorders
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Wounds and Injuries
- Hemorrhage
- Craniocerebral Trauma
- Trauma, Nervous System
- Intracranial Hemorrhages
- Intracranial Hemorrhage, Traumatic
- Hematoma
- Hematoma, Subdural
- Hematoma, Subdural, Chronic
- Physiological Effects of Drugs
- Anti-Infective Agents, Local
- Anti-Infective Agents
- Central Nervous System Depressants
- Ethanol
Other Study ID Numbers
- 201905146
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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