A Space-expanding Shield in Decompressive Hemicraniectomy for Stroke

NCT ID: NCT06638385

Last Updated: 2025-07-09

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

110 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-06-01

Study Completion Date

2030-06-30

Brief Summary

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Instead of the standard decompressive hemicraniectomy with subsequent cranioplasty a single surgery with the implantation of an individually molded space-expanding shield is investigated in for patients with increased intracranial pressure due to a malignant stroke.

Detailed Description

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Background:

A malignant cerebral infarction causes edema resulting in a threatening increase of the intracranial pressure (ICP). Standard of care is a surgical removal of a part of the skull above the ischemic brain, the so-called decompressive hemicraniectomy (DCE). DCE allows the brain to swell, after detumescence of the brain parenchyma (usually several months later) the patients undergo a second surgery with implantation of either their own preserved bone flap or a bone flap substitute (a procedure referred to as cranioplasty (CP)).

Objective:

Despite its proven life-saving benefits, the strategy of DCE followed by CP carries several risks, among others

* Exposure of the brain parenchyma
* Various neurological deficits subsumed under the syndrome of the trephined
* Bone resorption: As shown in a previous prospective cohort study the above-mentioned risks may be prevented using an intraoperatively molded space-expanding protective shield, which is implanted and fixed directly after having performed (a so far customary) DCE. This shield allows the brain to swell while still providing protection.

SPACE SHIELD investigates whether the single-stage strategy of implanting a space-expanding shield represents a viable alternative to the standard DCE followed by CP."

Methods:

The inclusion of patients is planned to take place from January 2025 to December 2029. The study duration for the individual patients is 6 months. While the intervention group will be treated with the above-described space-expanding shield the control group will be treated with the customary DCE and following CP. The CP will be performed either with the original bone flap stored in customary manner or with a PMME bone flap. Examinations of the patients are planned after 1 - 7 days, 6 weeks, 3 months and 6 months after the initial surgery.

Conditions

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Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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DCE + SPACE SHIELD

Patients in the experimental group receive a DCE with implantation of a space-expanding shield.

Group Type EXPERIMENTAL

DCE + SPACE SHIELD

Intervention Type PROCEDURE

Patients receive a DCE with implantation of a space-expanding shield.

DCE + CP

Patients in the control group receive a DCE similar to the intervention group, but without implantation of a space-expanding shield. Cranioplasty (CP) is performed after \~ 90 days in the customary manner.

Group Type ACTIVE_COMPARATOR

DCE + CP

Intervention Type PROCEDURE

Patients in the control group receive a DCE similar to the intervention group, but without implantation of a space-expanding shield. Cranioplasty (CP) is performed after \~ 90 days in the customary manner.

Interventions

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DCE + SPACE SHIELD

Patients receive a DCE with implantation of a space-expanding shield.

Intervention Type PROCEDURE

DCE + CP

Patients in the control group receive a DCE similar to the intervention group, but without implantation of a space-expanding shield. Cranioplasty (CP) is performed after \~ 90 days in the customary manner.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients with malignant infarction of the middle cerebral artery identified by MRI including diffusion-weighted imaging or CT including perfusion imaging - fulfilling the European guidelines for decompressive hemicraniectomy (DCE) for stroke
* ≥ 18 and \< 70 years of age
* Availability of consent from a next of kin and from the patient represented by an independent physician

Exclusion Criteria

* Hyperacute need for DCE due to rapid neurological decline
* Contraindications to the use of polymethyl-methacrylate (PMMA), e.g., known hypersensitivity, allergy
* Known gentamicin allergy
* Pregnancy and active breast-feeding
* Patients with a former history of DCE and/or CP
* Active pulmonary or cranial infection
* Known coagulopathy independent of medication
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Insel Gruppe AG, University Hospital Bern

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Schucht Philippe, MD

Role: PRINCIPAL_INVESTIGATOR

Inselspital Bern, Department of Neurosurgery

Locations

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Kantonsspital Aarau

Aarau, , Switzerland

Site Status RECRUITING

Universitätsspital Basel

Basel, , Switzerland

Site Status RECRUITING

Inselspital Bern, Department of Neurosurgery

Bern, , Switzerland

Site Status RECRUITING

Luzerner Kantonsspital

Lucerne, , Switzerland

Site Status RECRUITING

Ente Ospedaliero Cantonale

Lugano, , Switzerland

Site Status RECRUITING

Kantonsspital St.Gallen

Sankt Gallen, , Switzerland

Site Status RECRUITING

Countries

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Switzerland

Central Contacts

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Philippe Schucht, MD

Role: CONTACT

+41316322409

Kissling Cédric, MD

Role: CONTACT

+41316322409

Facility Contacts

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Gerrit A Schubert, MD

Role: primary

+41628386690

Jehuda Soleman, MD

Role: primary

+4617041330

Cédric Kissling, MD

Role: primary

+41316322409

Schucht Philippe, MD

Role: backup

+41316322409

Ulf C Schneider, MD

Role: primary

+41412054504

Andrea Cardia

Role: primary

+41918116283

Hostettler C Isabel, MD

Role: primary

+41714941199

Other Identifiers

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SPACE SHIELD

Identifier Type: -

Identifier Source: org_study_id

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