- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06123325
Psychiatric Outcomes of Unruptured Intracranial Aneurysms (POUIA) (POUIA)
December 4, 2023 updated by: Montefiore Medical Center
Impact of Observation Versus Treatment on The Psychiatric and Mental Outcomes of Patients With Unruptured Intracranial Aneurysms
The impact of cerebrovascular procedures on patients experiencing anxiety and depression is not well studied despite the high prevalence of these mental health disorders.
Unruptured Intracranial aneurysms (UIAs) have a prevalence of approximately 3% and an annual risk of 1-2% in the general population.
Despite the high risk of fatality following aneurysm rupture with a rate of 40-50%, the overall aneurysm growth and rupture risks are rare (less than 3% per aneurysm per year) and many patients can be observed with serial follow-up imaging over years.
Nevertheless, due to the gravity of the bad consequences of aneurysm rupture, simply informing many patients of UIA diagnosis has been found to result in worse outcomes of health-related quality of life.
This study aims to investigate the impact of awareness of untreated UIA on the patients' mental health utilizing the Hospital Anxiety and Depression Scale (HADS) tool.
Study Overview
Status
Recruiting
Intervention / Treatment
Detailed Description
This is a controlled, non-randomized, prospective cohort study with parallel arms of treatment arm with microsurgical and endovascular treatment and comparison control arm with conservative management/observation of UIA.
The goal of this study is to investigate the impact of the awareness of an untreated UIA on the psychiatric and mental status of the patients enrolled in the control arm compared to patients with a treated UIA.
All patients presenting to the outpatient clinic upon the initiation of the trial and for 2 years ahead with UIA diagnosed on any of the angiographic imaging modalities including Computed Tomography Angiography (CTA), Magnetic Resonance Angiography (MRA), and Digital Subtraction Angiogram (DSA) will be included.
Study Type
Observational
Enrollment (Estimated)
200
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: Muhammed Amir Essibayi, MD
- Phone Number: 718-920-7498
- Email: muhammedamir.essibayi@einsteinmed.edu
Study Contact Backup
- Name: Genesis Liriano, MD
- Phone Number: 718-920-2469
- Email: gliriano@montefiore.org
Study Locations
-
-
New York
-
Bronx, New York, United States, 10467
- Recruiting
- Montefiore Medical Center
-
Contact:
- David J Altschul, MD
- Phone Number: 718-920-7498
- Email: daltschu@montefiore.org
-
Principal Investigator:
- David J Altschul, MD
-
Sub-Investigator:
- Muhammed Amir Essibayi, MD
-
-
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
- Adult
- Older Adult
Accepts Healthy Volunteers
N/A
Sampling Method
Non-Probability Sample
Study Population
All patients present to our outpatient clinic with unruptured intracranial aneurysms diagnosed on any of the angiographic imaging modalities including CTA, MRA, and Digital Subtraction Angiogram (DSA) and meet the eligibility criteria will be asked by a nurse practitioner or a research fellow to participate in the study.
Description
Inclusion Criteria:
- Unruptured intracranial aneurysms (UIA)
- mRS scores between 0-1
Observation Group: All patients with UIAs that are eligible for conservative management.
- Specific locations that are not good candidates for interventional treatment, such as cavernous internal carotid artery and very distally located aneurysms.
- Aneurysm size (largest dimension) is less than 4 mm.
- Treatment Group: All Patients with UIAs that are decided to be treated either with endovascular or microsurgical treatments due to several reasons, such as aneurysm size above 4 mm, patient's decision.
Exclusion Criteria:
- Prior history of intracranial hemorrhage.
- Prior history of intracranial aneurysm
- Severe comorbidities that impact the mental health of the patients, such severe psychiatric disease, and chronic end stage diseases.
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 |
---|---|
Treatment group
Patients with unruptured intracranial aneurysms, opting for active intervention undergo microsurgical clipping or endovascular therapy to preemptively secure the aneurysm and prevent rupture.
|
Microsurgical clipping of intracranial aneurysms involves craniotomy to access the brain, locating the aneurysm, and placing a small metal clip across its neck, thereby isolating it from normal blood circulation to prevent rupture.
Any endovascular embolization of intracranial aneurysms that involves navigating microcatheters through the vascular system to the site of the aneurysm and deploying materials like coils, flow-diverting stents, or endosaccular flow disruptors to occlude the aneurysm and reduce the risk of rupture.
|
Observation group
Patients with unruptured intracranial aneurysms, opting for conservative management undergo regular monitoring with serial imaging to track aneurysm stability, deferring interventional treatment unless changes indicate an increased risk of rupture.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Anxiety
Time Frame: 6 months and 18 months
|
The number of participants demonstrating anxiety will be determined using the Hospital Anxiety and Depression Scale (HADS) assessment tool.
HADS is a widely used tool to evaluate anxiety and depression levels and is composed of 14 items in total, 7 items for anxiety and 7 for depression.
The 7 anxiety subscale items are to be answered subjectively by patients using a four-point Likert scale (0-3) with a possible scoring range of 0-21 for anxiety.
The number of participants with HADS scores of 8 and above will be considered to demonstrate positive signs of anxiety.
|
6 months and 18 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Depression
Time Frame: 6 months and 18 months
|
The number of participants demonstrating depression will be determined using the Hospital Anxiety and Depression Scale (HADS) assessment tool.
HADS is a widely used tool to evaluate anxiety and depression levels and is composed of 14 items in total, 7 items for anxiety and 7 for depression.
The 7 depression subscale items are to be answered subjectively by patients using a four-point Likert scale (0-3) with a possible scoring range of 0-21 for depression.
The number of participants with HADS scores of 8 and above will be considered to demonstrate positive signs of depression.
|
6 months and 18 months
|
Aneurysm rupture
Time Frame: 6 months and 18 months
|
The number of participants with any recorded event of aneurysm rupture during the follow-up periods of observed or treated Unruptured Intracranial Aneurysm (UIA) will be determined.
|
6 months and 18 months
|
Significant Aneurysm Growth
Time Frame: 6 months and 18 months
|
The number of participants demonstrating significant aneurysm growth during the follow-up periods will be determined.
Significant aneurysm growth is defined as any aneurysm growth of >= 3 millimeters of observed or treated UIA.
|
6 months and 18 months
|
Change in Neurologic Status
Time Frame: 6 months and 18 months
|
The number of participants with change in neurologic status will be determined using the National Institute of Health (NIH) Stroke Scale/Score (NIHSS).
The NIHSS is a 15-item neurological examination with each item scored on a 3- to 5-point scale, with 0 as normal.
Scores range from 0-42 and there is an allowance for untestable items.
Progressive increase in NIHSS score by 2 or more points after the procedure and through study completion will be considered as a bad outcome.
|
6 months and 18 months
|
Functional Outcome Status
Time Frame: 6 months and 18 months
|
The number of participants demonstrating favorable functional outcome status will be assessed using a modified Rankin Scale (mRS) score.
Participants with scores ranging from 0 (no disability) to 2 (slight disability) will be considered to have a favorable functional outcome status.
Participants with mRS scores ranging from 3 (Moderate disability) to 5 (severe disability) will be considered to have an unfavorable functional outcomes status.
|
6 months and 18 months
|
Acute adverse events
Time Frame: During admission
|
The number of acute adverse events during hospital admission will be tabulated.
Acute adverse events will encompass management and procedure-related complications.
Increased incidence of procedure-related complications portends more unfavorable outcomes.
|
During admission
|
Delayed adverse events
Time Frame: 3 months
|
The number of delayed adverse events will be tabulated.
Delayed adverse events will encompass management and procedure-related complications.
Increased incidence of procedure-related complications portends more unfavorable outcomes.
|
3 months
|
Procedure-related death
Time Frame: During admission
|
All procedure- and management-related mortality events occurring during admission will be recorded.
|
During admission
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: David J Altschul, MD, Associate Professor at The Leo M. Davidoff Department of Neurological Surgery at Montefiore
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)
December 1, 2023
Primary Completion (Estimated)
March 1, 2026
Study Completion (Estimated)
March 1, 2026
Study Registration Dates
First Submitted
November 3, 2023
First Submitted That Met QC Criteria
November 3, 2023
First Posted (Actual)
November 8, 2023
Study Record Updates
Last Update Posted (Actual)
December 5, 2023
Last Update Submitted That Met QC Criteria
December 4, 2023
Last Verified
December 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2023-15285
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.
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