Remote Ischemic Conditioning for the Treatment of Intracerebral Hemorrhage

NCT ID: NCT04657133

Last Updated: 2022-07-19

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

Clinical Phase

PHASE3

Total Enrollment

452 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-04-22

Study Completion Date

2023-06-30

Brief Summary

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Intracerebral hemorrhage (ICH) results from the rupture of small vessels damaged by chronic hypertension, amyloid angiopathy or other disease. Currently, ICH has been a devastating type of stroke that lacking effective therapy. Remote ischemic conditioning (RIC), a systematically protective strategy, has been found to have neuroprotective effects by in patients with ischemic stroke. In addition, animal studies show that RIC is safe in ICH model and it could accelerate the absorption of hematoma. In a previous clinical study (RICH-1), RIC have been found to be safe and well-tolerated in patients with ICH. Therefore, the investigators plan to undertake this study to further evaluate the safety and efficacy of RIC in patients with ICH.

The investigators hypothesize that treatment with RIC will accelerate the absorption of hematoma and improve patients' functional outcomes. Results of this study can potentially bring into account new means to improve the outcomes of ICH patients.

Detailed Description

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Conditions

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Intracerebral Hemorrhage Acute Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Intervention group

Subjects in the intervention group will receive remote ischemic conditioning and standard background medical treatment.

Group Type EXPERIMENTAL

Remote ischemic conditioning

Intervention Type DEVICE

RIC is a non-invasive therapy that performed by an electric autocontrol device with cuff placed on arm. RIC procedures consist of five cycles of 5-min inflation (200 mmHg) and 5-min deflation of cuff on one arm. The procedure will be performed once daily for consecutive 7 days after enrollment.

Standard medication therapy

Intervention Type DRUG

Standard medication therapy will be performed according to the national and international guidelines.

Sham group

Subjects in the placebo group will receive sham remote ischemic conditioning and standard background medical treatment alone.

Group Type PLACEBO_COMPARATOR

Sham remote ischemic conditioning

Intervention Type DEVICE

Sham RIC will be performed by the same electric autocontrol device with cuff placed on arm. Sham RIC procedures consist of five cycles of 5-min inflation (30 mmHg) and 5-min deflation of cuff on one arm. The procedure will be performed once daily for consecutive 7 days after enrollment.

Standard medication therapy

Intervention Type DRUG

Standard medication therapy will be performed according to the national and international guidelines.

Interventions

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Remote ischemic conditioning

RIC is a non-invasive therapy that performed by an electric autocontrol device with cuff placed on arm. RIC procedures consist of five cycles of 5-min inflation (200 mmHg) and 5-min deflation of cuff on one arm. The procedure will be performed once daily for consecutive 7 days after enrollment.

Intervention Type DEVICE

Sham remote ischemic conditioning

Sham RIC will be performed by the same electric autocontrol device with cuff placed on arm. Sham RIC procedures consist of five cycles of 5-min inflation (30 mmHg) and 5-min deflation of cuff on one arm. The procedure will be performed once daily for consecutive 7 days after enrollment.

Intervention Type DEVICE

Standard medication therapy

Standard medication therapy will be performed according to the national and international guidelines.

Intervention Type DRUG

Other Intervention Names

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RIC Sham RIC

Eligibility Criteria

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Inclusion Criteria

1. Age ≥ 18 and ≤ 80 years
2. The diagnosis of supratentorial ICH is confirmed by brain CT scan
3. Hematoma volume of 10 to 30 ml and Glasgow Coma Score (GCS)\>8 at randomization.
4. National Institutes of Health Stroke Scale (NIHSS)≥6 and ≤20 points at randomization.
5. Randomization and starting treatment between 24 and 48 hours of symptom ictus.
6. Signed and dated informed consent is obtained.

Exclusion Criteria

1. Planned surgical evacuation of ICH prior to administration of investigational intervention
2. ICH concomitant with subarachnoid hemorrhage or intraventricular hemorrhage
3. Suspected secondary ICH related to tumor, ruptured aneurysm or arteriovenous malformation, hemorrhagic transformation of an ischemic infarct, or venous sinus thrombosis
4. Patients with a pre-existing neurological deficit (mRS\>1) or psychiatric disease that would confound the neurological or functional evaluations.
5. Coagulopathy - defined as elevated aPTT or INR \>1.3 upon presentation; concurrent use of direct thrombin inhibitors (such as dabigatran), direct factor Xa inhibitors (such as rivaroxaban or apixaban), or low-molecular-weight heparin
6. Severe renal disease (i.e., renal disorder requiring dialysis ) or eGFR \<30ml/min/1.73m2
7. Severe liver disorder, or ALT \>3 times or bilirubin \>2 times upper limit of normal
8. Known severe hearing loss or cognitive impairment
9. Known pregnancy, or positive pregnancy test, or breastfeeding
10. Patients known or suspected of not being able to comply with the study protocol due to alcoholism, noncompliance or any other cause
11. Life expectancy of less than 90 days due to co-morbid conditions
12. Concurrent participation in another research protocol for investigation of another experimental therapy
13. Severe, sustained hypertension (Systolic blood pressure\> 180 mmHg or diastolic blood pressure\> 110 mmHg).
14. Contraindication for remote ischemic conditioning: severe soft tissue injury, fracture, or peripheral vascular disease in the upper limbs.
15. Any condition which, in the judgement of the investigator, might increase the risk to the patient.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Capital Medical University

OTHER

Sponsor Role lead

Responsible Party

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Ji Xunming,MD,PhD

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Xuanwu Hospital, Capital Medical University

Beijing, Beijing Municipality, China

Site Status ACTIVE_NOT_RECRUITING

Beijing Red Cross Emergency Rescue Center

Beijing, Beijing Municipality, China

Site Status ACTIVE_NOT_RECRUITING

Beijing Renhe Hospital

Beijing, Beijng, China

Site Status NOT_YET_RECRUITING

Chengde Central Hospital

Chengde, Hebei, China

Site Status RECRUITING

The Six People's Hospital of Hengshui

Hengshui, Hebei, China

Site Status RECRUITING

Nanshi Hospital of Nanyang

Nanyang, Henan, China

Site Status RECRUITING

Tongliao Municipal Hosptial

Tongliao, Inner Mongolia, China

Site Status NOT_YET_RECRUITING

The First People's Hospital of Changzhou

Changzhou, Jiangsu, China

Site Status RECRUITING

The Affiliated Hospital of Xuzhou Medical University

Xuzhou, Jiangsu, China

Site Status RECRUITING

Tianjin Huanhu Hospital

Tianjin, Tianjin Municipality, China

Site Status RECRUITING

Jiaxing Second Hospital

Jiaxing, Zhejiang, China

Site Status NOT_YET_RECRUITING

Shaoxing People's Hospital

Shaoxing, Zhejiang, China

Site Status RECRUITING

Zhuji People's Hospital of Zhejaing Province

Zhuji, Zhejiang, China

Site Status ACTIVE_NOT_RECRUITING

Countries

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China

Central Contacts

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Xunming Ji, MD, PhD

Role: CONTACT

010-83199430

Wenbo Zhao, MD, PhD

Role: CONTACT

86-13120136877

Facility Contacts

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Na Li, M.D.

Role: primary

Jiangtao Zhang

Role: primary

Xinjing Gao

Role: primary

Rongyao Ma

Role: primary

Yaoming Xu, M.D.

Role: primary

Song Yang, M.D.

Role: primary

Deqin Geng, MD

Role: primary

Ming Wei, MD

Role: primary

Jianguo Shen

Role: primary

Xuebin Yu, MD

Role: primary

References

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Shoamanesh A, Patrice Lindsay M, Castellucci LA, Cayley A, Crowther M, de Wit K, English SW, Hoosein S, Huynh T, Kelly M, O'Kelly CJ, Teitelbaum J, Yip S, Dowlatshahi D, Smith EE, Foley N, Pikula A, Mountain A, Gubitz G, Gioia LC. Canadian stroke best practice recommendations: Management of Spontaneous Intracerebral Hemorrhage, 7th Edition Update 2020. Int J Stroke. 2021 Apr;16(3):321-341. doi: 10.1177/1747493020968424. Epub 2020 Nov 11.

Reference Type BACKGROUND
PMID: 33174815 (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)

Zhao W, Jiang F, Li S, Liu G, Wu C, Wang Y, Ren C, Zhang J, Gu F, Zhang Q, Gao X, Gao Z, Song H, Ma Q, Ding Y, Ji X; RICH-1 Investigators. Safety and efficacy of remote ischemic conditioning for the treatment of intracerebral hemorrhage: A proof-of-concept randomized controlled trial. Int J Stroke. 2022 Apr;17(4):425-433. doi: 10.1177/17474930211006580. Epub 2021 Apr 7.

Reference Type BACKGROUND
PMID: 33739197 (View on PubMed)

Other Identifiers

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RICH-2

Identifier Type: -

Identifier Source: org_study_id

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