The TESLA Trial: Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke

NCT ID: NCT03805308

Last Updated: 2024-04-23

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

COMPLETED

Clinical Phase

NA

Total Enrollment

300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-07-16

Study Completion Date

2023-11-18

Brief Summary

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The primary objective of the trial is to establish the effectiveness of IAT (versus medical management) in patients with moderate-large infarcts (NCCT ASPECTS 2-5) at baseline, with adaptive enrichment to better define the upper limit of infarct volume for treatment eligibility. Furthermore, the investigators aim to determine whether certain subgroups of patients with large baseline infarcts will have a greater treatment benefit. Finally, the investigators will assess the agreement of ASPECTS scores between site investigators, the core imaging lab, and automated software.

Detailed Description

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Prospective, randomized, open-label, blinded endpoint study. Patients presenting with symptoms of AIS who have evidence of a moderate-large infarct volume (Non-contrast CT Alberta Stroke Program Early CT score \[NCCT ASPECTS\] 2-5 in the anterior circulation will be assigned to either best medical management alone (including IV rtPA) or intra-arterial treatment (IAT) with mechanical thrombectomy added to best medical management. Each treated patient will be followed and assessed for 3 months after randomization.

Conditions

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Ischemic Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

TESLA is a pragmatic, phase III, prospective, randomized, open-label, blinded endpoint, multicenter trial. Patients with moderate-large infarcts will be assigned to either best medical management alone (including intravenous recombinant tissue-type plasminogen activator (IV rtPA)) or intra-arterial treatment (IAT) with mechanical thrombectomy added to best medical management. Mechanical thrombectomy will be performed with FDA-approved thrombectomy devices in accordance with the instructions for use (IFU). Patients will be enrolled at up to 25 centers over an anticipated three-year period, with an additional year for trial closeout.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
The patient and the treating physician will be aware of the treatment assignment. Assessment of outcome on NIHSS and mRS will be performed by a certified rater blinded to the treatment allocation. Each site must designate one or more individual(s) to perform these blinded assessments at 24 (16-36) hours, 6 ± 1 days or discharge (whichever is earlier), 30 days ± 7 days, and 90 days ± 30 days from randomization.

Neuroimaging core lab evaluation will also be assessed in a blinded manner, except for angiographic revascularization grading which will only be performed for the intra-arterial treatment arm.

Information on treatment allocation will be stored separately from the main study database. An unblinded independent statistician will combine treatment allocation data with the clinical data in order to report to the DSMB. A second blinded statistician will be part of the steering committee.

Study Groups

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Medical Management

Patients randomized to the medical therapy arm will receive standard medical therapy based on current AHA guidelines.

Group Type NO_INTERVENTION

No interventions assigned to this group

Intra-arterial Therapy

For patients randomized to the intra-arterial therapy arm, sites will use local protocols for femoral access, sedation, heparin infusion, monitoring, etc. Mechanical thrombectomy will be performed with FDA-approved thrombectomy devices in accordance with the IFU.

Group Type EXPERIMENTAL

Intra-arterial Therapy

Intervention Type PROCEDURE

Mechanical Thrombectomy is a treatment for stroke that removes clots that block large blood vessels.

Interventions

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Intra-arterial Therapy

Mechanical Thrombectomy is a treatment for stroke that removes clots that block large blood vessels.

Intervention Type PROCEDURE

Other Intervention Names

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Thrombectomy

Eligibility Criteria

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Inclusion Criteria

1. 18 to 85 years of age
2. Presenting with symptoms consistent with an acute ischemic stroke
3. Imaging evidence of an anterior circulation occlusion of the Internal Carotid Artery (ICA) terminus and/or Middle Cerebral Artery Main Stem (MCA M1) segment
4. NIHSS score \>6 at the time of randomization
5. Ability to randomize within 24 hours of stroke onset
6. Pre-stroke mRS score 0-1
7. Ability to obtain signed informed consent

Imaging evidence of moderate-large infarct defined as:

1\. NCCT ASPECTS 2-5

Exclusion Criteria

1. Females who are pregnant, or those of child-bearing potential with positive urine or serum beta Human Chorionic Gonadotropin (HCG) test
2. Known severe allergy (more than a rash) to contrast media uncontrolled by medications
3. Refractory hypertension (defined as persistent systolic blood pressure \>185 mmHg or diastolic blood pressure \>110 mmHg)
4. CT evidence of the following conditions:

* Midline shift or herniation
* Evidence of intracranial hemorrhage
* Mass effect with effacement of the ventricles
5. Computed Tomography Angiography (CTA) evidence suggestive of difficult endovascular access per the treating interventionalist
6. Presence of cervical ICA occlusion (e.g., related to atherosclerotic disease or dissection)
7. Rapidly improving neurological status prior to randomization to NIHSS \<6
8. Bilateral strokes or multiple intracranial occlusions
9. Intracranial tumors
10. Known hemorrhagic diathesis, coagulation factor deficiency, or on anticoagulant therapy with an International Normalized Ratio (INR) of \>3.0 or Partial Thromboplastin Time (PTT) \>3 times of normal
11. Baseline platelet count \<30,000 per microliter (µl)
12. Life expectancy less than 90 days prior to stroke onset
13. Participation in another randomized clinical trial that could confound the evaluation of the study
14. Any other condition (in the opinion of the site investigator) that precludes an endovascular procedure or poses a significant hazard to the patient if an endovascular procedure was performed
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Mercy Health Ohio

OTHER

Sponsor Role lead

Responsible Party

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Dr. Osama O. Zaidat

Neuroscience and Stroke Medical Director

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Albert J Yoo, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Texas Stroke Institute

Osama O Zaidat, MD, MS

Role: PRINCIPAL_INVESTIGATOR

Mercy Health St. Vincent Medical Center

Locations

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Baptist Health Center for Clinical Research

Little Rock, Arkansas, United States

Site Status

PIH Health Good Samaritan Hospital and PIH Health Whittier Hospital

Los Angeles, California, United States

Site Status

Pomona Valley Hospital Medical Center

Pomona, California, United States

Site Status

Sutter Institute for Medical Research

Sacramento, California, United States

Site Status

California Pacific Medical Center & Mills Peninsula Medical Center

San Francisco, California, United States

Site Status

Los Robles Hospital and Medical Center

Thousand Oaks, California, United States

Site Status

Providence Saint John's Health Center

Torrance, California, United States

Site Status

Boca Raton Regional Hospital Inc.

Boca Raton, Florida, United States

Site Status

University of Miami

Coral Gables, Florida, United States

Site Status

Tenet Health Systems (Delray Medical Center, St. Mary's Medical Center, Palmetto General Hospital)

Delray Beach, Florida, United States

Site Status

Orlando Health Inc.

Orlando, Florida, United States

Site Status

University of South Florida

Tampa, Florida, United States

Site Status

Wellstar Health System, Inc.

Marietta, Georgia, United States

Site Status

The University of Chicago

Chicago, Illinois, United States

Site Status

Northwestern University

Evanston, Illinois, United States

Site Status

AMITA Resurrection Medical Center and AMITA Saint Joseph Medical Center

Lisle, Illinois, United States

Site Status

Central DuPage Hospital Association d/b/a Northwestern Medicine Central DuPage Hospital

Winfield, Illinois, United States

Site Status

Lutheran Medical Group

Fort Wayne, Indiana, United States

Site Status

Munster Medical Research Foundation

Munster, Indiana, United States

Site Status

The University of Iowa

Iowa City, Iowa, United States

Site Status

Baptist Healthcare System Inc. d/b/a Baptist Health Lexington

Lexington, Kentucky, United States

Site Status

LSU Health Sciences Center at Shreveport

Shreveport, Louisiana, United States

Site Status

University of Massachusetts

Worcester, Massachusetts, United States

Site Status

McLaren Health Care Corporation

Grand Blanc, Michigan, United States

Site Status

Western Michigan University Homer Stryker MD School of Medicine and Bronson Methodist Hospital

Kalamazoo, Michigan, United States

Site Status

Sparrow Clinical Research Institute

Lansing, Michigan, United States

Site Status

SSM Health DePaul Hospital

Bridgeton, Missouri, United States

Site Status

Saint Louis University

St Louis, Missouri, United States

Site Status

The Community Hospital Group Inc. t/a JFK Medical Center

Edison, New Jersey, United States

Site Status

Rutgers The State University

Piscataway, New Jersey, United States

Site Status

University of Buffalo

Buffalo, New York, United States

Site Status

Feinstein Institute for Medical Research, Northwell

Manhasset, New York, United States

Site Status

ProMedica Toledo Hospital

Toledo, Ohio, United States

Site Status

Mercy Health St. Vincent Medical Center

Toledo, Ohio, United States

Site Status

Medical University of South Carolina

Charleston, South Carolina, United States

Site Status

Texas Tech University of Health Sciences

El Paso, Texas, United States

Site Status

The University of Texas Health Science Center at Houston

Houston, Texas, United States

Site Status

Texas Stroke Institute

Plano, Texas, United States

Site Status

University of Utah

Salt Lake City, Utah, United States

Site Status

Virginia Commonwealth University

Richmond, Virginia, United States

Site Status

Valley Medical Center

Renton, Washington, United States

Site Status

West Virginia University

Morgantown, West Virginia, United States

Site Status

Aurora Research Institute

Milwaukee, Wisconsin, United States

Site Status

Countries

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United States

References

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Writing Committee for the TESLA Investigators; Yoo AJ, Zaidat OO, Sheth SA, Rai AT, Ortega-Gutierrez S, Given CA 2nd, Zaidi SF, Grandhi R, Cuellar H, Mokin M, Katz JM, Alshekhlee A, Taqi MA, Ansari SA, Siddiqui AH, Barazangi N, English JD, Maud A, Kirmani J, Gupta R, Yavagal DR, Tarpley J, Pandya DJ, Cress MC, Dharmadhikari S, Asif KS, Kass-Hout T, Puri AS, Janjua N, Majjhoo AQ, Badruddin A, Edgell RC, Khatri R, Morgan L, Razak A, Zha A, Khandelwal P, Mueller-Kronast N, Rivet DJ, Wolfe T, Snelling B, Sultan-Qurraie A, Lin SP, Khangura R, Spiotta AM, Bhuva P, Salazar-Marioni S, Lin E, Tarabishy AR, Samaniego EA, Kolikonda MK, Jumaa MA, Reddy VK, Sharma P, Berkhemer OA, van Doormaal PJ, van Es ACGM, van Zwam WH, Emmer BJ, Beenen LF, Majoie CBLM, Buderer N, Detry MA, Bosse A, Graves TL, Saunders C, Elijovich L, Jadhav A, Patterson M, Slight H, Below K, Al Kasab S; TESLA Investigators. Thrombectomy for Stroke With Large Infarct on Noncontrast CT: The TESLA Randomized Clinical Trial. JAMA. 2024 Sep 23;332(16):1355-66. doi: 10.1001/jama.2024.13933. Online ahead of print.

Reference Type DERIVED
PMID: 39374319 (View on PubMed)

Roaldsen MB, Jusufovic M, Berge E, Lindekleiv H. Endovascular thrombectomy and intra-arterial interventions for acute ischaemic stroke. Cochrane Database Syst Rev. 2021 Jun 14;6(6):CD007574. doi: 10.1002/14651858.CD007574.pub3.

Reference Type DERIVED
PMID: 34125952 (View on PubMed)

Other Identifiers

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2018-49

Identifier Type: -

Identifier Source: org_study_id

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