Cervical Spinal Cord Stimulation in Cerebral Vasospasm

NCT ID: NCT02426827

Last Updated: 2018-03-22

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

WITHDRAWN

Clinical Phase

NA

Study Classification

INTERVENTIONAL

Study Start Date

2016-07-31

Study Completion Date

2018-04-30

Brief Summary

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The study is a non-blinded evaluation of the use of cervical spinal cord stimulation (SCS) for treatment of patients with Hunt and Hess grade 1-2 subarachnoid hemorrhage and evidence of cerebral vasospasm.

Detailed Description

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The study is a non-blinded evaluation of the use of cervical spinal cord stimulation (SCS) for treatment of patients with Hunt and Hess grade 1-2 subarachnoid hemorrhage and evidence of cerebral vasospasm. Stimulation will be provided with electrodes placed percutaneously in the upper cervical epidural space. The outcome of 5 patients will be studied with focus on possible adverse events related to the intervention. Vasospasm response to treatment will be measured as a secondary outcome. Middle cerebral artery flow velocity will be followed by transcranial Doppler and clinical outcome measured by NIH stroke scale. Flow velocities will be monitored daily by transcranial Doppler and NIH stroke scale performed daily for 7 days, after which spinal cord stimulation will be discontinued and the epidural lead removed.

Conditions

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Cerebral Vasospasm

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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SCS in CV

Group Type EXPERIMENTAL

Spinal Cord Stimulation

Intervention Type DEVICE

Interventions

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Spinal Cord Stimulation

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* a history of aneurysmal subarachnoid hemorrhage and will have aneurysm secured by clipping or coiling.
* evidence of vasospasm on TCD with MCA mean flow velocity \>120 cm/s.
* Patients must be clinically stable to leave the ICU for the study intervention.
* Patients will have Hunt and Hess grade 1-2 non-traumatic subarachnoid hemorrhage.
* Patient should be oriented patients able to provide informed consent.

Exclusion Criteria

* Patients with non-aneurysmal hemorrhage
* Patient with coagulopathy (PTT\>40, or INR \> 1.2)
* thrombocytopenia (platelets \<100 x 103 per mm2).
* Use of anticoagulation or antiplatelet medication within the known clinical effective period of the particular medication.
* allergy to nimodipine.
* History of cervical or thoracic spine surgery.
* Skin infection at site of catheter placement.
* Sepsis. Pregnancy. Age less than 18 or greater than 80. Active diagnosis of cancer or history of metastatic cancer. Presence of cardiac defibrillator. Inability or unwillingness of patient to give informed consent. Patients found to be clinically neurologically unstable, hemodynamically unstable, or suffering from unstable intracranial pressure at the time of assessment for lead placement will not have the intervention.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mayo Clinic

OTHER

Sponsor Role lead

Responsible Party

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Scott C. Palmer, M.D.

PI

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Scott C Palmer, MD

Role: PRINCIPAL_INVESTIGATOR

Mayo Clinic

References

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Goellner E, Slavin KV. Cervical spinal cord stimulation may prevent cerebral vasospasm by modulating sympathetic activity of the superior cervical ganglion at lower cervical spinal level. Med Hypotheses. 2009 Sep;73(3):410-3. doi: 10.1016/j.mehy.2009.01.055. Epub 2009 May 5.

Reference Type BACKGROUND
PMID: 19409714 (View on PubMed)

North R, Shipley J, Prager J, Barolat G, Barulich M, Bedder M, Calodney A, Daniels A, Deer T, DeLeon O, Drees S, Fautdch M, Fehrenbach W, Hernandez J, Kloth D, Krames ES, Lubenow T, North R, Osenbach R, Panchal SJ, Sitzman T, Staats P, Tremmel J, Wetzel T, American Academy of Pain Medicine. Practice parameters for the use of spinal cord stimulation in the treatment of chronic neuropathic pain. Pain Med. 2007 Dec;8 Suppl 4:S200-75. doi: 10.1111/j.1526-4637.2007.00388.x. No abstract available.

Reference Type BACKGROUND
PMID: 17995571 (View on PubMed)

Hosobuchi Y. Electrical stimulation of the cervical spinal cord increases cerebral blood flow in humans. Appl Neurophysiol. 1985;48(1-6):372-6. doi: 10.1159/000101161.

Reference Type BACKGROUND
PMID: 3879799 (View on PubMed)

Hosobuchi Y. Treatment of cerebral ischemia with electrical stimulation of the cervical spinal cord. Pacing Clin Electrophysiol. 1991 Jan;14(1):122-6. doi: 10.1111/j.1540-8159.1991.tb04056.x.

Reference Type BACKGROUND
PMID: 1705326 (View on PubMed)

Takanashi Y, Shinonaga M. Spinal cord stimulation for cerebral vasospasm as prophylaxis. Neurol Med Chir (Tokyo). 2000 Jul;40(7):352-6; discussion 356-7. doi: 10.2176/nmc.40.352.

Reference Type BACKGROUND
PMID: 10927901 (View on PubMed)

Visocchi M. Neuromodulation of cerebral blood flow by spinal cord electrical stimulation: the role of the Italian school and state of art. J Neurosurg Sci. 2008 Jun;52(2):41-7.

Reference Type BACKGROUND
PMID: 18500217 (View on PubMed)

Smith CC, Lin JL, Shokat M, Dosanjh SS, Casthely D. A report of paraparesis following spinal cord stimulator trial, implantation and revision. Pain Physician. 2010 Jul-Aug;13(4):357-63.

Reference Type BACKGROUND
PMID: 20648204 (View on PubMed)

Turner JA, Loeser JD, Deyo RA, Sanders SB. Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systematic review of effectiveness and complications. Pain. 2004 Mar;108(1-2):137-47. doi: 10.1016/j.pain.2003.12.016.

Reference Type BACKGROUND
PMID: 15109517 (View on PubMed)

Pluijms WA, Slangen R, Joosten EA, Kessels AG, Merkies IS, Schaper NC, Faber CG, van Kleef M. Electrical spinal cord stimulation in painful diabetic polyneuropathy, a systematic review on treatment efficacy and safety. Eur J Pain. 2011 Sep;15(8):783-8. doi: 10.1016/j.ejpain.2011.01.010. Epub 2011 Feb 22.

Reference Type BACKGROUND
PMID: 21345703 (View on PubMed)

Lysakowski C, Walder B, Costanza MC, Tramer MR. Transcranial Doppler versus angiography in patients with vasospasm due to a ruptured cerebral aneurysm: A systematic review. Stroke. 2001 Oct;32(10):2292-8. doi: 10.1161/hs1001.097108.

Reference Type BACKGROUND
PMID: 11588316 (View on PubMed)

Other Identifiers

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14-007493

Identifier Type: -

Identifier Source: org_study_id

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