- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06034847
Treatment of Persistent Distal Occlusion After Successful Proximal Recanalization in Thrombectomy (2BE3)
In stroke patients, mechanical thrombectomy is now the standard of care when the stroke is due to large proximal cerebral vessel occlusion. The purpose of the 2BE3 trial is to test whether adjunct rescue treatment of persisting distal occlusions after successful proximal recanalization of the large vessel occlusion can be proposed as an additional intervention to restore reperfusion of affected stroke tissue and improve clinical outcomes.
The rescue therapies will be either mechanical (small stent retrievers and/or small aspiration catheters) or pharmacological (infusion of intra-arterial thrombolytics).
Patients will be randomized to conservative management (mechanical thrombectomy with or without IV thrombolytics of large proximal vessels) or rescue therapy (mechanical or pharmacological interventions in distal vessels in addition to conservative management). Each patient will be followed for 3 months post-intervention.
The data collected will be clinical assessments and angiographic imaging to evaluate the reperfusion state.
Study Overview
Status
Conditions
Detailed Description
The purpose of the 2BE3 trial is to provide a clinical trial context for the use of rescue therapy (mechanical or pharmacological therapies) in patients with persistent distal occlusions after treatment of large vessel occlusions with mechanical thrombectomy and IV thrombolytics. The main hypothesis is that rescue therapy with mechanical or pharmacological therapies, compared with conservative management would result in improved clinical and reperfusion scores at 90 days.
The extent of reperfusion is an interesting therapeutic target because reperfusion status is a strong indicator of clinical outcome: grades of better reperfusion are incrementally associated with better clinical outcomes. Despite increased expertise of neuro-interventional teams and the evolution in thrombectomy devices, incomplete reperfusion occurs in almost half of patients undergoing treatment of large vessel occlusions. Thus, complementary treatments targeting distal occlusions and known as "rescue therapy" have been introduced to reach complete or near complete reperfusion.
The devices and techniques proposed as rescue therapies include small stent retrievers, small aspiration catheters and intra-arterial thrombolytics. Case studies and registries have shown high reperfusion rates and low rates of periprocedural complications; however, there is lack of randomized data to show the impact of rescue therapies on patient outcomes and safety compared to conservative management (treatment of large vessel occlusions only). A randomized clinical trial is therefore needed.
The 2BE3 trial is a simple randomized trial designed to be integrated into daily clinical practice. It will address whether rescue therapies truly offer a safe and more effective alternative to conservative management. Selection criteria are loose in order to be of use to most patients. Endpoints are simple, clinical, meaningful, valuable and resistant to bias. It includes no extra risk or cost of visits beyond what is required in routine care.
The design is multicenter, prospective, randomized, controlled, open-label study with blinded evaluation (PROBE design). The study population is acute ischemic stroke patients with persistent distal occlusions after treatment of large vessel occlusion with mechanical thrombectomy and/or intravenous thrombolysis. The total number of patients will be 300, 150 in each arm, each followed for 3 months post-intervention.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Daniela Iancu, MD
- Phone Number: 8450 15148908000
- Email: daniela.iancu.med@ssss.gouv.qc.ca
Study Contact Backup
- Name: Guylaine Gevry, BSc
- Phone Number: 27235 15148908000
- Email: guylaine.gevry.chum@ssss.gouv.qc.ca
Study Locations
-
-
Quebec
-
Montréal, Quebec, Canada, H2X 0A9
- CHUM - Centre Hospitalier de l'Universite de Montreal
-
Contact:
- Guylaine Gevry, BSc
- Phone Number: 27235 15148908000
- Email: guylaine.gevry.chum@ssss.gouv.qc.ca
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- any patient with a large vessel occlusion in the M1 or M2 segment of the MCA (Middle Cerebral Artery), supraclinoid ICA (Internal Carotid Artery), or basilar artery who is a candidate for thrombectomy
- with a persistent distal occlusion in M2-M4, A1-A5, P1-P5 after successful recanalization of the proximal clot with mechanical thrombectomy and/or IV thrombolysis
Exclusion Criteria:
- poor 3 month prognosis from comorbidities
- evidence of active bleeding on examination
- recent surgery with a significant risk of bleeding
- VKA (Vitamin K Antagonists) oral anticoagulation with INR (International Normalized Ratio) - > 1.7
- curative heparin or direct oral anticoagulants in previous 48 hours
- platelet count < 100 000/mm3
Study Plan
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 |
---|---|
Active Comparator: Conservative management
Mechanical thrombectomy of large vessel occlusions with or without administration of IV thrombolytics
|
mechanical thrombectomy with retrievable stents to remove clots in proximal large vessels, combined or not with distal aspiration, combined or not with IV thrombolytics
|
Active Comparator: Rescue therapy
In addition to conservative management, rescue therapy in distal occlusions consisting of either mechanical thrombectomy with small stent retrievers with or without contact aspiration, or intra-arterial pharmacotherapy with tPA (tissue Plasminogen Activator), uPA (urokinase Plasminogen Activator) or tenecteplase.
|
mechanical thrombectomy with retrievable stents to remove clots in proximal large vessels, combined or not with distal aspiration, combined or not with IV thrombolytics
In addition to mechanical thrombectomy in proximal large vessels, mechanical thrombectomy in distal vessels with small stent retrievers combined or not with contact aspiration, or intra-arterial perfusion of thrombolytics such as tPA or uPA or tenecpeplase
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of modified Rankin Scale score of 0-2. The modified Rankin score goes from 0 (no symptoms) to 6 (death). Higher scores mean a worse outcome
Time Frame: 90 days
|
proportion of patients with a modified Rankin Scale score of 0-2
|
90 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
score on the modified Rankin Scale. The modified Rankin score goes from 0 (no symptoms) to 6 (death). Higher scores mean a worse outcome
Time Frame: 90 days
|
score on the modified Rankin Scale
|
90 days
|
Rate of functional independence
Time Frame: 90 days
|
Functional independence is defined as a modified Rankin Scale score of 0-2
|
90 days
|
Change in NIHSS (National Institutes of Health Stroke Score) score. The scale goes from 0 to 42; higher scores indicated worse outcomes.
Time Frame: 24 hours
|
Difference between the NIHSS score at Registration and at 24 hours post-intervention
|
24 hours
|
Rate of NIHSS (National Institutes of Health Stroke Score) score improvement. The scale goes from 0 to 42; higher scores indicated worse outcomes.
Time Frame: 24 hours
|
Rate of decrease of 4 points or more in NIHSS score
|
24 hours
|
Rate of improved global ipsilateral hemispheric reperfusion
Time Frame: at end of procedure
|
blinded assessment of reperfusion on angiogram as measured by the modified TICI (Thrombolysis in Cerebral Infarction) scale.
The scale goes from 0 to 3; higher scores indicate better outcomes
|
at end of procedure
|
Rate of reperfusion
Time Frame: at end of procedure
|
assessed by the modified TICI (Thrombolysis in Cerebral Infarction) scale on angiogram.
The scale goes from 0 to 3; higher scores indicate better outcomes
|
at end of procedure
|
Rate of complete reperfusion
Time Frame: at end of procedure
|
a modified TICI (Thrombolysis in Cerebral Infarction) score of 3 on angiogram.
The scale goes from 0 to 3; higher scores indicate better outcomes
|
at end of procedure
|
Procedure time
Time Frame: at end of procedure
|
elapsed time from arterial puncture to last angiogram
|
at end of procedure
|
Number of thrombectomy passes
Time Frame: at end of procedure
|
Number of thrombectomy passes to achieve final reperfusion
|
at end of procedure
|
Mortality rate
Time Frame: 24 hours and 90 days
|
Rate of mortality
|
24 hours and 90 days
|
Rate of procedural complications
Time Frame: at end of procedure
|
defined as: vascular perforation, arterial dissection, new territory emboli, access site complication requiring surgical repair, subarachnoid hemorrhage
|
at end of procedure
|
Rate of symptomatic intracerebral hemorrhage
Time Frame: 24 hours
|
hemorrhage on CT or MRI according to the Heidelberg classification associated with a 4 point or greater worsening on the NIHSS score.
The Heidelberg classification goes from 1 to 3d; higher scores indicate worse outcomes.
|
24 hours
|
Rate of any intracranial hemorrhage
Time Frame: 24 hours
|
hemorrhage on CT or MRI according to the Heidelberg classification.
The Heidelberg classification goes from 1 to 3d; higher scores indicate worse outcomes.
|
24 hours
|
Collaborators and Investigators
Investigators
- Principal Investigator: Daniela Iancu, MD, Centre hospitalier de l'Université de Montréal (CHUM)
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2024-11741
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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