- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04581759
Endovascular Treatment and RIPC in Acute Ischemic Stroke (EnTRIPS)
May 6, 2022 updated by: First Affiliated Hospital Xi'an Jiaotong University
Endovascular Treatment Combined With Remote Ischemic Postconditioning in Patients With Acute Ischemic Stroke Improves the Prognosis,a Multicenter, Randomized, Prospective Trial
Endovascular treatment(ET)is an effective therapy for acute ischemic stroke(AIS) with great vessel obstruction.
However, acute complications such as high postoperative perfusion injury, hemorrhagic transformation and restenosis resulted in functional independence in only about 50% of patients 90 days after interventional surgery.
Therefore, it is very important to protect the neurologic function after emergency endovascular treatment.
The investigators' previous studies have shown that combined with intravenous thrombolytic therapy and remote postconditioning(RIPC)can significantly improve the neurological impairment and short-term and long-term prognosis in patients with acute stroke.
In this multicenter, randomized controlled trial, the investigators assumed patients with acute ischemic stroke who had successfully revascularization after ET might benefit from RIPC as well.
Patients in the RIPC group had five cycles of 5-min cuff inflation followed by 3-min deflation to the bilateral upper arm after ET.
The primary endpoint measure was the proportion of patients with a favorable recovery of nerve function deficient assessed by Modified Rankin Scale (mRS≤2) 90 days after surgery.
Secondary endpoints included the following: (1) Symptom endpoints: Neurological intelligence and function scores, postoperative hemorrhagic transformation rate, etc. (2) Blood index test: postoperative inflammatory factors, neuron-specific enolase (NSE) and other indicators.
(3) Imaging endpoints: MRI-FLAIR , TCD, etc.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Anticipated)
300
Phase
- Not Applicable
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
- Name: Guogang Luo, MD
- Phone Number: 0086-13991974085
- Email: lguogang@163.com
Study Contact Backup
- Name: Meng Wei, MD
- Phone Number: 0086-15991748135
- Email: 67183723@qq.com
Study Locations
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Shaanxi
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Xi'an, Shaanxi, China, 710061
- Recruiting
- First Affiliated Hospital of Xi'an Jiaotong University
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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 and older (ADULT, OLDER_ADULT)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- acute ischemic stroke(AIS) patients with large vessel occlusion (internal carotid artery system and vertebral basilar artery system) within 24 hours after onset, endovascular treatment (mechanical thrombotomy, intra-arterial thrombolysis, balloon dilatation or stent angioplastyand) successful opening were performed, and the definition of successful opening was defined by Modified Thrombolysis standard [Modified Thrombolysis in Cerebral infarction, mTICI]≥ 2B,The standards of endovascular interventional treatment are in line with the indications and contraindications formulated in the Chinese Guidelines for the Early Treatment of Acute Ischemic Stroke 2018;
- Modified Rankin scale score (mRS) ≤1 before onset:
- The Alberta Stroke Program Early CT score (ASPECTS)≥6 on admission;
- National Institute of Health Stroke Scale (NIHSS) score ≥6 on admission;
- Provision of written informed consent.
Exclusion Criteria:
- CT or MRI scan showed significant midline deviation and the mass effect;
- Glasgow(GCS) score ≤8 on admission;
- failure to accomplish 3-months and 6-months follow up;
- Severe cardiac, liver, or kidney disease, malignancy, severe coagulation dysfunction, severe anemia and systemic organ dysfunction;
- Pregnant or nursing women, or patients with moderate to severe mental disorders or dementia;
- Severe soft tissue injuries, fractures, thrombosis and other known peripheral vascular lesions of the upper limbs,active visceral hemorrhage, acute stage of fundus hemorrhage, cerebral aneurysm or cerebral arteriovenous malformation, and other unsuitable for bilateral upper arm compression.
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
- Masking: QUADRUPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
EXPERIMENTAL: RIPC
Patients in the RIPC group not only receive foundational treatment but also have five cycles of 5-min cuff inflation followed by 3-min deflation to the bilateral upper arm using a RIPC device (IPC-906X; Beijing Renqiao Institute of Neuroscience, Beijing, China) after endovascular treatment while in-hospital.
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Patients in the RIPC group will have five cycles of 5-min cuff inflation followed by 3-min deflation to the bilateral upper arm twice a day after Mechanical Thrombectomy.
foundational treatment, including free radical elimination in the acute stage, blood pressure and blood glucose stabilization, and antiplatelet (aspirin or/and clopidogrel ) and lipid-lowering (statins) drugs
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SHAM_COMPARATOR: foundational treatment group (FT)
Patients in the FT group only receive foundational treatment, including free radical elimination in the acute stage, blood pressure and blood glucose stabilization, and antiplatelet (aspirin or/and clopidogrel,100-300mg/d) and lipid-lowering (atorvastatin 20-60mg/d,rosuvastatin 10-20mg/d) drugs, during the study period without remote ischemic postconditioning after endovascular treatment.
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foundational treatment, including free radical elimination in the acute stage, blood pressure and blood glucose stabilization, and antiplatelet (aspirin or/and clopidogrel ) and lipid-lowering (statins) drugs
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Modified Rankin scale (mRS)
Time Frame: 7days, 90 days and 180 days after the surgery and at discharge
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The percentage of patients with a favorable outcome from baseline at 90 days and 180 days postoperatively, defined as a score of 0 or 2 on the modified Rankin scale (mRS)(Notes:mRS score from 0-6, higher scores mean worse outcome)
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7days, 90 days and 180 days after the surgery and at discharge
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The change of NIHSS score
Time Frame: 7days, 90 days and 180 days after the surgery and at discharge
|
The percentage of functional recovery from baseline at 90 days and 180 days postoperatively, as measured by the National Institute of Health Stroke Scale, short for NIHSS(Notes:NIHSS score from 0-42.
higher scores mean worse outcome)
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7days, 90 days and 180 days after the surgery and at discharge
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The change of Barthel Index
Time Frame: 7days, 90 days and 180 days after the surgery and at discharge
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The change of functional recovery from baseline at 90 days and 180 days postoperatively, as measured by the Barthel Index (Notes:Barthel Index score from 0-100.
higher scores mean better outcome)
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7days, 90 days and 180 days after the surgery and at discharge
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The change of Montreal Cognitive Assessment (MoCA) score
Time Frame: 7days, 90 days and 180 days after the surgery and at discharge
|
The change of cognitive recovery from baseline at 90 days and 180 days postoperatively, as measured by the MoCA (Notes:MoCA score from 0-30.
higher scores mean better outcome)
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7days, 90 days and 180 days after the surgery and at discharge
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The change of MMSE score
Time Frame: 7days, 90 days and 180 days after the surgery and at discharge
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The change of cognitive recovery from baseline at 90 days and 180 days postoperatively, as measured by the MMSE(Notes:MMSE score from 0-30.
higher scores mean better outcome)
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7days, 90 days and 180 days after the surgery and at discharge
|
The change of inflammatory indicators
Time Frame: before ET, 24 hours and 7 days after the surgery
|
Peripheral venous blood was drawn before Endovascular Treatment(ET) and 24 hours and 7 days postoperatively to determine the effect of repeated RIPC on anti-inflammatory (hIL-1β、hIL-2R、hIL-6、hIL8、hIL-10、S100-β、TNF-α) (Notes: unit ng/ml)
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before ET, 24 hours and 7 days after the surgery
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The change of angiogenic factors
Time Frame: before ET, 24 hours and 7 days after the surgery
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Peripheral venous blood was drawn before ET and 24 hours and 7 days postoperatively to determine the effect of repeated RIPC on vascular (VEGF、bFGF、EPO、HIF-1α、BDNF) and other pathways (S100B、NSE)(Notes: unit ng/ml)
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before ET, 24 hours and 7 days after the surgery
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The change of hemoglobin and Blood viscosity
Time Frame: up to 7 days after the surgery
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Peripheral venous blood was drawn before ET and 24 hours and 7 days postoperatively to determine the effect of repeated RIPC on Hb and Blood viscosity(Notes: unit g/L , mPa.s)
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up to 7 days after the surgery
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Postoperative hemorrhagic transformation
Time Frame: 72 hours after ET and hospitalization
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The proportion of patients with postoperative hemorrhagic transformation, based on CT scan and symptom
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72 hours after ET and hospitalization
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The change of MRI FLAIR Fazekas score
Time Frame: the changs from within 7 days to 90 days after the surgery
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Cerebral white matter demyelination measured by MRI FLAIR Fazekas score,(Notes:Fazekas score from 0-6. higher scores mean worse outcome)
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the changs from within 7 days to 90 days after the surgery
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The change of blood flow velocity
Time Frame: the changs from 24 hours after ET to 7 days after the surgery
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Vascular blood flow velocity measured by transcranial doppler (TCD) examination
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the changs from 24 hours after ET to 7 days after the surgery
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Vascular resistance
Time Frame: the changs from 24 hours after ET to 7 days after the surgery
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Vascular resistance measured by TCD examination
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the changs from 24 hours after ET to 7 days after the surgery
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mortality rate
Time Frame: up to 90 days and 180 days
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90-days and 180-days mortality rate
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up to 90 days and 180 days
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recurrence rate of cerebrovascular disease
Time Frame: up to 90 days and 180 days
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90-days and 180-days recurrence rate of cerebrovascular disease
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up to 90 days and 180 days
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blood pressure
Time Frame: up to 7days
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The effect of RIPC on blood pressure
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up to 7days
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heart rate
Time Frame: up to 7days
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The effect of RIPC on heart rate
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up to 7days
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
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)
April 12, 2021
Primary Completion (ANTICIPATED)
April 30, 2023
Study Completion (ANTICIPATED)
October 30, 2023
Study Registration Dates
First Submitted
September 9, 2020
First Submitted That Met QC Criteria
October 3, 2020
First Posted (ACTUAL)
October 9, 2020
Study Record Updates
Last Update Posted (ACTUAL)
May 10, 2022
Last Update Submitted That Met QC Criteria
May 6, 2022
Last Verified
April 1, 2022
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- XJTU1AF-CRF-2020-015
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
YES
IPD Sharing Time Frame
12/31/2023, for 1 year
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
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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