Perfusion Computer Tomography: Imaging and Clinical Validation Following Reperfusion Therapy in Acute Ischaemic Stroke

NCT ID: NCT02309970

Last Updated: 2014-12-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

90 participants

Study Classification

OBSERVATIONAL

Study Start Date

2014-12-31

Study Completion Date

2016-03-31

Brief Summary

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CT perfusion (CTP) of the brain is an innovative technique to identify rapidly regions which are only partially or insufficiently perfused during an acute ischemic event. The differentiation between the core infarct and the still viable penumbra is its major clinical application. CTP helps directly in the decision-making process in the event of acute ischemic stroke by increasing the potential of success in patient who can benefit from thrombolytic/endovascular treatment.

The use of CTP in patient selection for thrombolytic/endovascular treatment was never evaluated in a prospective randomized study. Yet, clinical experience well demonstrated a good correlation between the size of the penumbra and the clinical outcome when done in early as well as late stages of the event.

The importance of identifying the penumbra in the acute phase of the ischemic stroke is widely accepted. But crucial evidence to support the predictive value of CTP to predict the clinical and anatomical/structural outcomes in the late phases (90 days after) is lacking.

Currently, the use of CTP is based on theoretical assumptions and expert opinions but a randomized prospective study to validate its use is lacking.

The current guidelines restrict the use of CTP trials and to patients that can't performed MRI scan.

Detailed Description

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Conditions

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Ischemic Stroke

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Conservative

patient will get treatment with Antiplatelets or Anticoagulant depending on their clinical status/etiology

acetylsalicylic acid, clopidogrel bisulfate and/or warfarin, Apixaban, Rivaroxaban, Dabigatran

Intervention Type DRUG

subject in this group will receive oral treatment with anti platelet drug

IV tPA

patient will receive intravenous thrombolysis treatment

alteplase

Intervention Type DRUG

subject in this group will receive intravenous tPA

Endovascular treatment

patient who will receive endovascular treatment

endovascular

Intervention Type PROCEDURE

Interventions

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acetylsalicylic acid, clopidogrel bisulfate and/or warfarin, Apixaban, Rivaroxaban, Dabigatran

subject in this group will receive oral treatment with anti platelet drug

Intervention Type DRUG

alteplase

subject in this group will receive intravenous tPA

Intervention Type DRUG

endovascular

Intervention Type PROCEDURE

Other Intervention Names

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Aspirin, Plavix, Coumadin, Eliquis,Xarelto, Pradaxa, Sintrom subject in this group will undergo mechanical thrombectomy

Eligibility Criteria

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Inclusion Criteria

* NIHSS\>=8
* up to 6 hours from event onset

Exclusion Criteria

* mRS\>= 3 before the start of the event
* life expectency \<1 year because other disability disease
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Rabin Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Guy Raphaeli

Dr. Guy Raphaeli

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Guy Raphaeli, MD

Role: PRINCIPAL_INVESTIGATOR

Rabin Medical Center

Locations

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Rabin Medical Center

Petach Tiqva, Central District, Israel

Site Status

Countries

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Israel

Central Contacts

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Guy Raphaeli, MD

Role: CONTACT

Phone: 972-50-4065626

Email: [email protected]

Ophir Keret, MD

Role: CONTACT

Phone: 972-3-9377080

Email: [email protected]

Facility Contacts

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Guy Raphaeli, MD

Role: primary

References

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Bivard A, Spratt N, Levi C, Parsons M. Perfusion computer tomography: imaging and clinical validation in acute ischaemic stroke. Brain. 2011 Nov;134(Pt 11):3408-16. doi: 10.1093/brain/awr257.

Reference Type BACKGROUND
PMID: 22075524 (View on PubMed)

Koton S, Bornstein NM, Green MS. Population group differences in trends in stroke mortality in Israel. Stroke. 2001 Sep;32(9):1984-8. doi: 10.1161/hs0901.095407.

Reference Type RESULT
PMID: 11546885 (View on PubMed)

National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995 Dec 14;333(24):1581-7. doi: 10.1056/NEJM199512143332401.

Reference Type RESULT
PMID: 7477192 (View on PubMed)

Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008 Sep 25;359(13):1317-29. doi: 10.1056/NEJMoa0804656.

Reference Type RESULT
PMID: 18815396 (View on PubMed)

Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, Pessin M, Ahuja A, Callahan F, Clark WM, Silver F, Rivera F. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA. 1999 Dec 1;282(21):2003-11. doi: 10.1001/jama.282.21.2003.

Reference Type RESULT
PMID: 10591382 (View on PubMed)

Wardlaw JM, Zoppo G, Yamaguchi T, Berge E. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev. 2003;(3):CD000213. doi: 10.1002/14651858.CD000213.

Reference Type RESULT
PMID: 12917889 (View on PubMed)

Parsons M, Spratt N, Bivard A, Campbell B, Chung K, Miteff F, O'Brien B, Bladin C, McElduff P, Allen C, Bateman G, Donnan G, Davis S, Levi C. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. N Engl J Med. 2012 Mar 22;366(12):1099-107. doi: 10.1056/NEJMoa1109842.

Reference Type RESULT
PMID: 22435369 (View on PubMed)

Parsons MW. Perfusion CT: is it clinically useful? Int J Stroke. 2008 Feb;3(1):41-50. doi: 10.1111/j.1747-4949.2008.00175.x.

Reference Type RESULT
PMID: 18705914 (View on PubMed)

Goyal M, Menon BK, Derdeyn CP. Perfusion imaging in acute ischemic stroke: let us improve the science before changing clinical practice. Radiology. 2013 Jan;266(1):16-21. doi: 10.1148/radiol.12112134. No abstract available.

Reference Type RESULT
PMID: 23264523 (View on PubMed)

Gonzalez RG, Copen WA, Schaefer PW, Lev MH, Pomerantz SR, Rapalino O, Chen JW, Hunter GJ, Romero JM, Buchbinder BR, Larvie M, Hirsch JA, Gupta R. The Massachusetts General Hospital acute stroke imaging algorithm: an experience and evidence based approach. J Neurointerv Surg. 2013 May;5 Suppl 1(Suppl 1):i7-12. doi: 10.1136/neurintsurg-2013-010715. Epub 2013 Mar 14.

Reference Type RESULT
PMID: 23493340 (View on PubMed)

Abstracts of the 17th European Stroke Conference. Nice, France. May 13-16, 2008. Cerebrovasc Dis. 2008;25 Suppl 2:1-204. doi: 10.1159/000132086. No abstract available.

Reference Type RESULT
PMID: 22015331 (View on PubMed)

Other Identifiers

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GR 05 - 14

Identifier Type: -

Identifier Source: org_study_id