Efficacy of a Minimally Invasive Therapy Adjuvant to the Standards of Care by Cyanoacrylate Embolization

NCT ID: NCT05374681

Last Updated: 2026-01-27

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

550 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-03-28

Study Completion Date

2028-09-28

Brief Summary

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Chronic subdural hematomas (CSH) are collections of blood in the subdural space. CSH are becoming the most common cranial neurosurgical condition among adults, and a significant public health problem, due to an increasing use of anticoagulant and antiplatelet medication in an ageing population. Symptomatic CSH, or CSH with a significant mass effect, are treated surgically. However, recurrences are common (10 to 20%). Conservative management (medical) is used in patients who are asymptomatic or have minor symptoms. However, therapeutic failures, requiring surgical treatment, are common. The pathophysiology of CSH involves inflammation, angiogenesis, and clotting dysfunction. Self-perpetuation and rebleeding is thought to be caused by neo-membranes from the inflammatory remodeling of the dura-mater mainly fed by the distal branches of the middle meningeal artery (MMA). There are 13 ongoing registered RCTs in CSH, with the most common covering application of steroids, surgical techniques and tranexamic acid. Further to this, there are trials running on other pharmacological agents, and peri-operative management. Some industrial or academic trials are or will enroll in France in the next year in France. But to our best knowledge, none of these trials will the eventual benefits of the MMA embolization in both cases of medical and/or surgical management, and none will focus on the use of cyanoacrylates (CYA) for this purpose.

Preliminary case series and nonrandomized retrospective studies have suggested that MMA embolization alone or as adjuvant therapy to surgery can decrease recurrences.

The investigators hypothesize that in both conditions of conservative or surgical managements, endovascular embolization of patients with CSH significantly reduces the risk of recurrence of CSH. The investigators choose the CYA as liquid embolic agent because of the pain and cost of the use of Ethylen Vinyl alcohol copolymer (EVOH) agents and its simplicity to be used.

Detailed Description

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* Indication of surgical or conservative management will be decided by the neurosurgeon.
* Experimental arm:

CSH requiring hematoma removal will be surgically managed with a surgical technique applied depending on the surgeon's discretion.

Medical management will be adopted according to neurosurgeons habits. MMA embolization (on the CSH side or bilaterally if necessary) in the Experimental Arms will be performed with Cyanoacrylates and preferentially using conscious sedation or local anesthesia.

• Control arm: CSH requiring hematoma removal will be surgically managed with a surgical technique applied depending on the surgeon's discretion.

Medical management will be adopted according to neurosurgeons habits

• Primary and secondary end points will be assessed at 2 months+/- 1 month and assessed at 6 +/- 2 months. The blind items will be the mRS and the RACE score. The volume of the CSH will be semi-automatically assessed using the ABC/2 method and the estimated maximal thickness of the CSH on axial images.

Conditions

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Chronic Subdural Hematoma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Medical treatment alone

Medical treatment without embolization of the MMA.

Group Type OTHER

Medical treatment

Intervention Type OTHER

Medical treatment alone

Surgical treatment alone

Surgical treatment without embolization of the MMA.

Group Type OTHER

Surgical treatment

Intervention Type OTHER

Surgical treatment alone

Medical treatment associated with an embolization of the MMA

Medical treatment + embolization under local anesthesia or conscious sedation. The embolization will be carried out by femoral or radial arterial guided by pre-embolization cervical CTA. The middle meningeal artery will be catheterized then embolized by cyanoacrylates until the occlusion of the MMA.

Group Type EXPERIMENTAL

Medical treatment

Intervention Type OTHER

Medical treatment alone

embolization of the MMA

Intervention Type OTHER

The middle meningeal artery will be catheterized then embolized by cyanoacrylates until the occlusion of the MMA.

Surgical treatment associated with an embolization of the MMA

Surgical treatment + embolization under local anesthesia or conscious sedation. The embolization will be carried out by femoral or radial arterial guided by pre-embolization cervical CTA. The middle meningeal artery will be catheterized then embolized by cyanoacrylates until the occlusion of the MMA.

Group Type EXPERIMENTAL

Surgical treatment

Intervention Type OTHER

Surgical treatment alone

embolization of the MMA

Intervention Type OTHER

The middle meningeal artery will be catheterized then embolized by cyanoacrylates until the occlusion of the MMA.

Interventions

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Medical treatment

Medical treatment alone

Intervention Type OTHER

Surgical treatment

Surgical treatment alone

Intervention Type OTHER

embolization of the MMA

The middle meningeal artery will be catheterized then embolized by cyanoacrylates until the occlusion of the MMA.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patient with a more than 10 mm CSH confirmed by NCCT
* CSH localized to convexity
* Patient aged 18 years or more at the time of the enrollment
* Patient beneficiary from health insurance

Exclusion Criteria

* Any contraindication as required per angiogram procedure (severe renal failure ≥ 4, allergy…)
* Pre-existing severe disability resulting in baseline mRS score \> 3
* Life expectancy of less than 6 months due to another cause than CSH
* Patient under legal protection or deprived of liberty by a judicial or administrative decision
* Pregnant or breastfeeding women
* Vulnerable persons unable to give consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Brest

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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CHU Amiens-Picardie

Amiens, France, France

Site Status TERMINATED

CHU Brest

Brest, France, France

Site Status RECRUITING

CHU Caen

Caen, France, France

Site Status TERMINATED

Hôpital Henri Mondor

Créteil, France, France

Site Status RECRUITING

CHU Nantes

Nantes, France, France

Site Status RECRUITING

CHU Nice

Nice, France, France

Site Status RECRUITING

Hôpital Pitié Salpêtrière

Paris, France, France

Site Status RECRUITING

Hôpital Fondation Rothschild

Paris, France, France

Site Status RECRUITING

CHU Tours

Tours, France, France

Site Status TERMINATED

CHU Bordeaux

Bordeaux, , France

Site Status RECRUITING

CHU Nancy

Nancy, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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jean-Christophe GENTRIC, PhD

Role: CONTACT

0298347520

Facility Contacts

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Jean-Christophe GENTRIC, PhD

Role: primary

Lucas SCARCIA, Dr

Role: primary

Romain BOURCIER, Dr

Role: primary

Michel LONJON, Pr

Role: primary

Frédéric CLARENCON, Pr

Role: primary

William BOISSEAU, Dr

Role: primary

Gaultier MARNAT, Dr

Role: primary

Benjamin GORY, Pr

Role: primary

Other Identifiers

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29BRC22.0028

Identifier Type: -

Identifier Source: org_study_id

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