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Reperfusion With Cooling in Cerebral Acute Ischemia II (ReCCLAIM II)

11 septembre 2018 mis à jour par: Dr. Christopher Horn, WellStar Health System

Phase 2 Study of Mild Hypothermia in Combination With Acute Cerebral Vascular Reperfusion in the Setting of Acute Ischemic Stroke

The purpose of this study is to determine whether reducing a patients body temperature (mild hypothermia of 33 degrees Centigrade) will significantly reduce the risk of brain injury (notably reperfusion injury and hemorrhagic conversion) in patients that have suffered a significant interruption of blood flow to an area of brain (occlusion of large proximal cerebral artery) and have undergone successful removal of that interruption (revascularization).This will be achieved by comparing patients that have undergone hypothermia to those that have not.

Aperçu de l'étude

Statut

Retiré

Les conditions

Intervention / Traitement

Description détaillée

This study is designed to examine the safety and proof of concept of therapeutic hypothermia prior to conventional revascularization in subjects experiencing acute ischemic stroke by comparing the results to subjects who remain at normal body temperature (normothermic) and proceed directly to reperfusion via conventional reperfusion intervention. The investigational plan also examines the following outcomes in 85 subjects randomized to either hypothermia or normothermia:

  • Regulation of biomarkers indicative of ischemia-reperfusion injury
  • Changes in blood brain injury using the Hyperintense Acute Reperfusion Marker (HARM) protocol MRI as a surrogate imaging biomarker
  • Incidence of hemorrhagic conversion post reperfusion
  • Neurologic function at 90 days post acute ischemic stroke. The results of this study will be used to power a definitive phase III clinical trial evaluating the combination of hypothermia and revascularization versus reperfusion alone.

Type d'étude

Interventionnel

Phase

  • N'est pas applicable

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Lieux d'étude

    • Georgia
      • Atlanta, Georgia, États-Unis, 30303
        • Grady Memorial Hospital

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

18 ans à 85 ans (Adulte, Adulte plus âgé)

Accepte les volontaires sains

Non

Sexes éligibles pour l'étude

Tout

La description

Inclusion Criteria:

  • Male or female subjects of any ethnicity and age >/=18 but </= 85 years;
  • Symptom onset </=8 hours;
  • Symptoms consistent with an ischemic stroke with a large vessel occlusion (Middle Cerebral Artery (MCA), Internal Carotid Artery (ICA) terminus) as determined by vascular imaging, CT or MRI;
  • Alberta Stroke Program Early CT Score (ASPECTS) of 5-10 on non-contrast CT of the brain;
  • Ability to undergo endovascular reperfusion therapy;
  • No contraindications to general anesthesia or allergies to any components associated with the anticipated diagnostic or treatment procedures that cannot be treated;
  • A pre-treatment modified Rankin Scale (mRS) of 0 or 1;
  • Arterial puncture performed under 8 hours from symptom onset or last seen normal
  • Baseline MRI or CT scan shows no hemorrhage;
  • National Institutes of Health Stroke Scale (NIHSS) 14-29;
  • Subject has either 1) failed iv tissue plasminogen activator (tPA) therapy or 2) contradicted for iv tPA therapy;
  • Subject is capable of complying with study procedures and agrees to complete all required study procedures, study visits and associated activities.
  • Subject must be able to understand and give written informed consent.

Exclusion Criteria:

  • Females of childbearing potential who are pregnant or not using adequate contraception;
  • Bleeding diathesis with a platelet count < 50,000 or International Normalized Ratio (INR) >1.5 or any active or recent (within 10 to 30 days) hemorrhage;
  • History of genetically confirmed hypercoagulable syndrome;
  • Any condition that excludes MRI imaging;
  • History of dementia, currently on Aricept or Namenda, or other Alzheimer's like symptoms;
  • End stage renal disease on hemodialysis;
  • History of cardiac arrest;
  • Presence of an inferior vena cava (IVC) filter;
  • Contrast dye allergy with history of anaphylaxis, known serious sensitivity to contrast agents or any condition in which angiography is contraindicated;
  • Known allergy to meperidine or buspar;
  • Sustained hypertension (systolic blood pressure (SBP) > 185 or diastolic blood pressure (DBP) > 110 refractory to treatment);
  • Baseline CT/MRI of head showing evidence of mass effect with mid-line shift, hemorrhage, intracranial tumor, arterial vasculitis or dissection, or bilateral stroke;
  • Presence of any other serious comorbidity that would be likely to impact life expectancy to less than 6 months or limit subject cooperation or study compliance;
  • Concurrent participation in an investigational clinical study that has not completed the follow-up period or planned participation in another study within the next 3 months;
  • Subject has any other condition or personal circumstance that, in the judgment of the investigator, might interfere with the collection of complete, good quality data or the completion of the research study

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: Traitement
  • Répartition: Randomisé
  • Modèle interventionnel: Affectation parallèle
  • Masquage: Aucun (étiquette ouverte)

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Aucune intervention: Normothermia
As part of standard of care, an interventional reperfusion procedure will be performed on all subjects using current FDA approved devices. After which patient will be started on normothermia attempting to keep core body temp between 38 and 36.5 degrees centigrade. Patients will also undergo blood draws for biomarkers before reperfusion is achieved the immediately, 6 hours then 24 hours after reperfusion.
Expérimental: Mild Hypothermia
As part of standard of care, an interventional reperfusion procedure will be performed on all subjects using current FDA cleared device. Patient will also have a Quattro catheter placed in the femoral vein and temperature brought to 33 degrees centigrade as quickly as possible. They will stay in mild hypothermia for 12 hours and then be rewarmed very slowly. Patients will also undergo blood draws for biomarkers before reperfusion is achieved the immediately, 6 hours then 24 hours after reperfusion.
Hypothermia will be achieved using the Zoll Thermoguard XP technology with the Quattro catheter. This catheter has a 9.3 Fr diameter and is 4 3cm long. It will be placed in the patients femoral vein via Seldinger technique, before reperfusion is achieved. Hypothermia will be initiated prior to reperfusion. Once temperature has reached 33.5 degrees centigrade the patient will remain at that temperature for 12 hours after which the patient will undergo active gradual rewarming at 0.2 degrees centigrade per hour.
Autres noms:
  • Hypothermie
  • Therapeutic Hypothermia

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Description de la mesure
Délai
Nombre de participants avec événements indésirables
Délai: 90 jours
Évaluation et détermination des complications suivantes : pneumonies, infections du cathéter central, hémorragies intracérébrales, hémorragies systémiques, ischémie cérébrale transitoire et nouveaux accidents vasculaires cérébraux.
90 jours

Mesures de résultats secondaires

Mesure des résultats
Description de la mesure
Délai
Hyperintense Acute Reperfusion Marker (HARM)
Délai: 48+/- 24 hours
HARM is a MRI sequence looking at gadolinium enhancement on FLAIR MRI imaging.
48+/- 24 hours
Hemorrhagic Conversion
Délai: 48hrs
Acute bleeding into the area of the original stroke based on CT or MRI of the head.
48hrs
National Institutes of Health Stroke Scale (NIHSS)
Délai: 90 days
NIHSS is a scale from 1-42 to evaluate stroke severity
90 days
Modified Rankin Scale (mRS)
Délai: 90 days
mRS is a straightforward evaluation of the functional limitations from stroke
90 days
Biomarkers
Délai: Before therapy then immediately after, 8hrs, and 24hrs after reperfusion
These biomarkers are indicative of ischemia-reperfusion injury
Before therapy then immediately after, 8hrs, and 24hrs after reperfusion

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Les enquêteurs

  • Chercheur principal: Christopher Horn, MD, Emory University
  • Directeur d'études: Rishi Gupta, MD, Emory University

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude

1 février 2013

Achèvement primaire (Anticipé)

1 février 2015

Achèvement de l'étude (Anticipé)

1 juin 2015

Dates d'inscription aux études

Première soumission

5 septembre 2012

Première soumission répondant aux critères de contrôle qualité

13 novembre 2012

Première publication (Estimation)

20 novembre 2012

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Réel)

13 septembre 2018

Dernière mise à jour soumise répondant aux critères de contrôle qualité

11 septembre 2018

Dernière vérification

1 septembre 2018

Plus d'information

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .

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