A Clinical Trial About the Safety of Surgical Treatment in Severe Primary Pontine Hemorrhage

NCT ID: NCT04647162

Last Updated: 2023-12-08

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

RECRUITING

Clinical Phase

NA

Total Enrollment

64 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-01-01

Study Completion Date

2024-11-30

Brief Summary

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Primary pontine hemorrhage (PPH) is not common but is the most catastrophic subtype of intracerebral hemorrhage, with acute mortality between 30% and 60%. For severe PPH, defined as Glasgow Coma score (GCS) \<8 and hematoma volume≥5ml, the mortality rate is as high as 80-100%. Guidelines from the American Heart Association and European Stroke Organization do not make definite specifications. More than a century after Finkelnburg first explored the brainstem for hematoma, however, plenty of researches have shown surgery can save lives and improve the prognosis for selective patients and can be an effective and safe treatment. This study is proposed to validate the safety of surgical treatment in severe primary pontine hemorrhage.

Detailed Description

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The study is being conducted from Jan 2022 to Nov 2024 in 20 neurosurgical units. This STIPE trial is an investigator-initiated, parallel (3:1 to surgical HE or MT), multi-centre, randomized controlled open-label trial following the Consolidated Standards of Reporting Trials (CONSORT) guidelines and will be conducted from Jan 2022 to Nov 2024 in 20 Tertiary hospitals in China. The flow chart of the clinical trial is presented in Figure 1. Neurosurgeons involved in the study are senior investigators with good clinical experience in sPPH management. Moreover, all investigators are well trained centrally according to the requirements.

Conditions

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Cerebrovascular Disorders Pontine Hemorrhage Primary Surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

A sample size of 60 would be required to demonstrate a significant level of 5% (two-sided) with 80% power. Considering the 6% missing rate during follow-up, the total sample size was 64 cases with 16 and 48 cases in MT and HE group, respectively.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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medical group

Patients receive only medical treatment including active life support, nutritional support, homeostasis maintenance of the internal environment, and other symptomatic treatment.

Group Type ACTIVE_COMPARATOR

life support

Intervention Type OTHER

The treatments in medical group includes life support, nutrition support, and rehabilitation therapy。

surgical group

Patients receive intervention such as the evacuation of hematoma under craniotomy or by stereotactic puncture or neuroendoscopy.

Group Type EXPERIMENTAL

hematoma evacuation by craniotomy

Intervention Type PROCEDURE

The intervention method of hematoma evacuation is under craniotomy.

hematoma evacuation by stereotactic puncture

Intervention Type PROCEDURE

The intervention method of hematoma evacuation is under stereotactic puncture.

hematoma evacuation by neuroendoscopy

Intervention Type PROCEDURE

The intervention method of hematoma evacuation is under neuroendoscopy.

Interventions

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hematoma evacuation by craniotomy

The intervention method of hematoma evacuation is under craniotomy.

Intervention Type PROCEDURE

hematoma evacuation by stereotactic puncture

The intervention method of hematoma evacuation is under stereotactic puncture.

Intervention Type PROCEDURE

hematoma evacuation by neuroendoscopy

The intervention method of hematoma evacuation is under neuroendoscopy.

Intervention Type PROCEDURE

life support

The treatments in medical group includes life support, nutrition support, and rehabilitation therapy。

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Clinical diagnosis of PPH: patients have acute hemorrhage mainly in pons with a definite history of hypertension.
2. GCS 5\~7 and HV≥5ml on admission (the HV in intraventricular system being excluded).
3. Family members consenting to randomize and signing informed consent form (ICF).
4. Time from onset to admission less than 24 hours.
5. Age:18 years or older.

Exclusion Criteria

1. Structural lesions such as brainstem cavernous malformation, arteriovenous malformation, aneurysm, tumor apoplexy.
2. GCS≥8 and HV\<5ml.
3. Time from onset to admission over 24 hours.
4. Patients with platelet count \< 100,000, International Normalized Ratio (INR)\> 1.4, or an elevated prothrombin time (PT) and activated partial thromboplastin time (APTT).
5. Multiple ICH.
6. Accompanying hydrocephalus that requires surgical management
7. Irreversible brainstem failure (bilateral fixed, dilated pupils and extensor motor posturing, GCS≤4).
8. A previous history of ICH.
9. Any serious concurrent illness that would interfere with the safety assessments including hepatic, renal, gastroenterologic, respiratory, cardiovascular, endocrinologic, immunologic, and hematologic disease.
10. Pregnant patients.
11. Patients' family members refuse HE.
12. Any other condition that the investigator believes would present a significant hazard to the subject if the investigational therapy were initiated.
13. Participating in another simultaneous trial of ICH treatment.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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West China Hospital

OTHER

Sponsor Role lead

Responsible Party

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Chao You, MD

former director of the department of neurosurgery, West China Hospital

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Chao You, MD

Role: PRINCIPAL_INVESTIGATOR

West China Hospital

Locations

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The First Affiliated Hospital of Anhui Medical University

Hefei, Anhui, China

Site Status RECRUITING

The First Affiliated Hospital of Fujian Medical University

Fuzhou, Fujian, China

Site Status RECRUITING

Gaozhou Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine

Gaozhou, Guangdong, China

Site Status RECRUITING

Guangdong Sanjiu Brain Hospital

Guangzhou, Guangdong, China

Site Status RECRUITING

University of Chinese Academy of Sciences Shenzhen Hospital

Shenzhen, Guangdong, China

Site Status RECRUITING

The Second Affiliated Hospital of South China University of Technology

Shenzhen, Guangdong, China

Site Status RECRUITING

Zhuhai People's Hospital

Zhuhai, Guangdong, China

Site Status RECRUITING

The First Affiliated Hospital of Harbin Medical University

Harbin, Heilongjiang, China

Site Status RECRUITING

The Second Affiliated Hospital of Zhengzhou University

Zhengzhou, Henan, China

Site Status RECRUITING

General Hospital of the Eastern Theater

Nanjing, Jiangsu, China

Site Status RECRUITING

Shanxi Bethune hospital

Taiyuan, Shanxi, China

Site Status RECRUITING

West China Hospital of Sichuan University

Chengdu, Sichuan, China

Site Status RECRUITING

Mianyang Central Hospital

Mianyang, Sichuan, China

Site Status RECRUITING

Affiliated Hospital of North Sichuan Medical College

Nanchong, Sichuan, China

Site Status RECRUITING

The Third Hospital of the People's Liberation Army

Baoji, , China

Site Status RECRUITING

The seventh medical center of the Army General Hospital

Beijing, , China

Site Status RECRUITING

Second Affiliated Hospital of Zhejiang University School of Medicine

Hangzhou, , China

Site Status RECRUITING

Huashan Hospital of Fudan University

Shanghai, , China

Site Status RECRUITING

Shanghai No.10 hospital

Shanghai, , China

Site Status RECRUITING

Xuhui Hospital of Zhongshan Hospital affiliated to Fudan

Shanghai, , China

Site Status RECRUITING

Countries

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China

Central Contacts

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Chao You, MD

Role: CONTACT

Phone: +86 028-85422488

Email: [email protected]

Qiang He, MD

Role: CONTACT

Phone: +86 15099189463

Email: [email protected]

Facility Contacts

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Hongwei Cheng, MD

Role: primary

Dezhi Kang, MD

Role: primary

Jinhua Yang, MD

Role: primary

Linsen Mu, MD

Role: primary

Xuezheng Fan, MD

Role: primary

Jiangang Liu, MD

Role: primary

Gang Chen, MD

Role: primary

Hongsheng Liang, MD

Role: primary

Zhan Liu, MD

Role: primary

Chiyuan Ma, MD

Role: primary

Xinming Ding, MD

Role: primary

Chao You, MD

Role: primary

Zongping Li, MD

Role: primary

Xiaoping Tang, MD

Role: primary

Rongjun Zhang

Role: primary

Hongtian Zhang, MD

Role: primary

Fengqiang Liu

Role: primary

Jian Yu, MD

Role: primary

Liang Gao, MD

Role: primary

Shujie Sun, MD

Role: primary

References

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Morotti A, Jessel MJ, Brouwers HB, Falcone GJ, Schwab K, Ayres AM, Vashkevich A, Anderson CD, Viswanathan A, Greenberg SM, Gurol ME, Romero JM, Rosand J, Goldstein JN. CT Angiography Spot Sign, Hematoma Expansion, and Outcome in Primary Pontine Intracerebral Hemorrhage. Neurocrit Care. 2016 Aug;25(1):79-85. doi: 10.1007/s12028-016-0241-2.

Reference Type BACKGROUND
PMID: 26759226 (View on PubMed)

Ye Z, Huang X, Han Z, Shao B, Cheng J, Wang Z, Zhang Z, Xiao M. Three-year prognosis of first-ever primary pontine hemorrhage in a hospital-based registry. J Clin Neurosci. 2015 Jul;22(7):1133-8. doi: 10.1016/j.jocn.2014.12.024. Epub 2015 May 14.

Reference Type BACKGROUND
PMID: 25982189 (View on PubMed)

Tao C, Li H, Wang J, You C. Predictors of Surgical Results in Patients with Primary Pontine Hemorrhage. Turk Neurosurg. 2016;26(1):77-83. doi: 10.5137/1019-5149.JTN.12634-14.1.

Reference Type BACKGROUND
PMID: 26768872 (View on PubMed)

Huang K, Ji Z, Sun L, Gao X, Lin S, Liu T, Xie S, Zhang Q, Xian W, Zhou S, Gu Y, Wu Y, Wang S, Lin Z, Pan S. Development and Validation of a Grading Scale for Primary Pontine Hemorrhage. Stroke. 2017 Jan;48(1):63-69. doi: 10.1161/STROKEAHA.116.015326. Epub 2016 Dec 8.

Reference Type BACKGROUND
PMID: 27932606 (View on PubMed)

Indredavik B, Bakke F, Slordahl SA, Rokseth R, Haheim LL. Stroke unit treatment. 10-year follow-up. Stroke. 1999 Aug;30(8):1524-7. doi: 10.1161/01.str.30.8.1524.

Reference Type BACKGROUND
PMID: 10436094 (View on PubMed)

Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015 Jul;46(7):2032-60. doi: 10.1161/STR.0000000000000069. Epub 2015 May 28.

Reference Type BACKGROUND
PMID: 26022637 (View on PubMed)

Steiner T, Al-Shahi Salman R, Beer R, Christensen H, Cordonnier C, Csiba L, Forsting M, Harnof S, Klijn CJ, Krieger D, Mendelow AD, Molina C, Montaner J, Overgaard K, Petersson J, Roine RO, Schmutzhard E, Schwerdtfeger K, Stapf C, Tatlisumak T, Thomas BM, Toni D, Unterberg A, Wagner M; European Stroke Organisation. European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage. Int J Stroke. 2014 Oct;9(7):840-55. doi: 10.1111/ijs.12309. Epub 2014 Aug 24.

Reference Type BACKGROUND
PMID: 25156220 (View on PubMed)

Lui TN, Fairholm DJ, Shu TF, Chang CN, Lee ST, Chen HR. Surgical treatment of spontaneous cerebellar hemorrhage. Surg Neurol. 1985 Jun;23(6):555-8. doi: 10.1016/0090-3019(85)90002-3.

Reference Type BACKGROUND
PMID: 3992454 (View on PubMed)

Ichimura S, Bertalanffy H, Nakaya M, Mochizuki Y, Moriwaki G, Sakamoto R, Fukuchi M, Fujii K. Surgical Treatment for Primary Brainstem Hemorrhage to Improve Postoperative Functional Outcomes. World Neurosurg. 2018 Dec;120:e1289-e1294. doi: 10.1016/j.wneu.2018.09.055. Epub 2018 Sep 19.

Reference Type BACKGROUND
PMID: 30244074 (View on PubMed)

Mangiardi JR, Epstein FJ. Brainstem haematomas: review of the literature and presentation of five new cases. J Neurol Neurosurg Psychiatry. 1988 Jul;51(7):966-76. doi: 10.1136/jnnp.51.7.966.

Reference Type BACKGROUND
PMID: 3060565 (View on PubMed)

Rohde V, Berns E, Rohde I, Gilsbach JM, Ryang YM. Experiences in the management of brainstem hematomas. Neurosurg Rev. 2007 Jul;30(3):219-23; discussion 223-4. doi: 10.1007/s10143-007-0081-9. Epub 2007 May 8.

Reference Type BACKGROUND
PMID: 17486379 (View on PubMed)

Murata Y, Yamaguchi S, Kajikawa H, Yamamura K, Sumioka S, Nakamura S. Relationship between the clinical manifestations, computed tomographic findings and the outcome in 80 patients with primary pontine hemorrhage. J Neurol Sci. 1999 Aug 15;167(2):107-11. doi: 10.1016/s0022-510x(99)00150-1.

Reference Type BACKGROUND
PMID: 10521548 (View on PubMed)

Cao S, Zheng M, Hua Y, Chen G, Keep RF, Xi G. Hematoma Changes During Clot Resolution After Experimental Intracerebral Hemorrhage. Stroke. 2016 Jun;47(6):1626-31. doi: 10.1161/STROKEAHA.116.013146. Epub 2016 Apr 28.

Reference Type BACKGROUND
PMID: 27125525 (View on PubMed)

Wilkinson DA, Keep RF, Hua Y, Xi G. Hematoma clearance as a therapeutic target in intracerebral hemorrhage: From macro to micro. J Cereb Blood Flow Metab. 2018 Apr;38(4):741-745. doi: 10.1177/0271678X17753590. Epub 2018 Jan 19.

Reference Type BACKGROUND
PMID: 29350086 (View on PubMed)

Parraga RG, Possatti LL, Alves RV, Ribas GC, Ture U, de Oliveira E. Microsurgical anatomy and internal architecture of the brainstem in 3D images: surgical considerations. J Neurosurg. 2016 May;124(5):1377-95. doi: 10.3171/2015.4.JNS132778. Epub 2015 Oct 30.

Reference Type BACKGROUND
PMID: 26517774 (View on PubMed)

He Q, Wang J, Ma L, Li H, Tao C, You C. Safety of surgical Treatment In severe primary Pontine haemorrhage Evacuation (STIPE): study protocol for a multi-centre, randomised, controlled, open-label trial. BMJ Open. 2022 Aug 23;12(8):e062233. doi: 10.1136/bmjopen-2022-062233.

Reference Type DERIVED
PMID: 35998952 (View on PubMed)

Other Identifiers

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STIPE

Identifier Type: -

Identifier Source: org_study_id