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REperfusion With Cooling in CerebraL Acute IscheMia II (RECCLAIM-II)

Primary Purpose

Ischemic Stroke, Hypothermia

Status
Withdrawn
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Normothermia
Mild hypothermia
Trevo Pro Retriever (Stryker Corp.)
Zoll Thermogard XP technology with the Quattro catheter
Sponsored by
WellStar Health System
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Ischemic Stroke focused on measuring Acute ischemic stroke, Mild hypothermia, Stroke, Hypothermia, Cerebral infarction, Ischemia, Cerebrovascular disorder, Brain disease, Central nervous system disease, Nervous system disease, Vascular disease, Cardiovascular disease, Brain infarction, Brain ischemia, Pathologic process, Body temperature change, Signs and symptoms

Eligibility Criteria

18 Years - 79 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female subjects of any ethnicity and age >/=18 but </= 79 years;
  • Symptom onset </=8 hours;
  • Symptoms consistent with an ischemic stroke with a large vessel occlusion (Middle Cerebral Artery (MCA), Internal Carotid Artery (ICA) terminus) as determined by CT imaging of the brain;
  • Alberta Stroke Program Early CT Score (ASPECTS) of 5-10 on non-contrast CT of the brain;
  • Ability to undergo endovascular reperfusion therapy;
  • No contraindications to general anesthesia, conscious sedation, or allergies to any components associated with the anticipated diagnostic or treatment procedures that cannot be treated;
  • A pre-treatment modified Rankin Scale (mRS) of 0 or 1;
  • Baseline CT scan shows no hemorrhage;
  • National Institutes of Health Stroke Scale (NIHSS) 14-29;
  • Subject has either 1) failed iv tissue plasminogen activator (tPA) therapy or 2) contradicted for iv tPA therapy;
  • Subject is capable of complying with study procedures and agrees to complete all required study procedures, study visits and associated activities.
  • Subject or legally authorized representative must be able to understand and give written informed consent.

Exclusion Criteria:

  • Females of childbearing potential who are pregnant or not using adequate contraception;
  • Bleeding diathesis with a platelet count < 50,000 or International Normalized Ratio (INR) >1.7 or any active or recent (within 10 to 30 days) hemorrhage;
  • History of genetically confirmed hypercoagulable syndrome;
  • Any condition that excludes MRI imaging;
  • History of dementia, currently on Aricept or Namenda, or other Alzheimer's-like symptoms;
  • End stage renal disease on hemodialysis;
  • History of cardiac arrest;
  • Presence of an inferior vena cava (IVC) filter;
  • Contrast dye allergy with history of anaphylaxis, known serious sensitivity to contrast agents or any condition in which angiography is contraindicated;
  • Known allergy to meperidine or buspar;
  • Prior neurologic event that would obscure interpretation of the signal and current presenting neurologic deficits;
  • Sustained hypertension (systolic blood pressure (SBP) > 185 or diastolic blood pressure (DBP) > 110 refractory to treatment);
  • Baseline CT/MRI of head showing evidence of mass effect with mid-line shift, hemorrhage, intracranial tumor, arterial vasculitis or dissection, or bilateral stroke;
  • Presence of any other serious comorbidity that would be likely to impact life expectancy to less than 6 months or limit subject cooperation or study compliance;
  • Concurrent participation in an investigational clinical study that has not completed the follow-up period or planned participation in another study within the next 3 months;
  • Any other condition or personal circumstance that, in the judgment of the investigator, might interfere with the collection of complete, good quality data or the completion of the research study.

Sites / Locations

  • WellStar Kennestone Regional Medical Center

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Normothermia

Mild hypothermia

Arm Description

As part of standard of care, an interventional reperfusion procedure will be performed on all subjects using the Trevo Pro Retriever (Stryker), after which normothermia will attempt to keep core body temp between 38 and 36.5 degrees centigrade.

As part of standard of care, an interventional reperfusion procedure will be performed on all subjects using the Trevo Pro Retriever (Stryker). Subjects will also have a catheter placed in the femoral vein (Zoll Thermogard XP technology with the Quattro catheter) and temperature brought to 33 degrees centigrade as quickly as possible. They will stay in mild hypothermia for 12 hours, and then be rewarmed very slowly.

Outcomes

Primary Outcome Measures

Hemorrhagic Conversion
Acute bleeding into the area of the original stroke based on CT or MRI of the head.

Secondary Outcome Measures

Hyperintense Acute Reperfusion Marker (HARM)
HARM is a MRI sequence looking at gadolinium enhancement on FLAIR MRI imaging.
National Institutes of Health Stroke Scale (NIHSS)
NIHSS is a scale from 1-42 to evaluate stroke severity
Modified Rankin Scale (mRS)
mRS is a straightforward evaluation of the functional limitations from stroke
Number of participants with adverse events
Evaluation and determination of the following complications pneumonias, central line infections, intra-cerebral hemorrhages, systemic hemorrhages, transient cerebral ischemia, and new strokes.

Full Information

First Posted
March 25, 2015
Last Updated
February 16, 2016
Sponsor
WellStar Health System
Collaborators
Zoll Medical Corporation
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1. Study Identification

Unique Protocol Identification Number
NCT02411877
Brief Title
REperfusion With Cooling in CerebraL Acute IscheMia II
Acronym
RECCLAIM-II
Official Title
REperfusion With Cooling in CerebraL Acute IscheMia II
Study Type
Interventional

2. Study Status

Record Verification Date
February 2016
Overall Recruitment Status
Withdrawn
Why Stopped
It was decided that it was not feasible to continue this study.
Study Start Date
February 2016 (undefined)
Primary Completion Date
November 2017 (Anticipated)
Study Completion Date
November 2017 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
WellStar Health System
Collaborators
Zoll Medical Corporation

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to determine whether reducing a patient's body temperature (mild hypothermia of 33 degrees Centigrade) will significantly reduce the risk of brain injury (notably reperfusion injury and hemorrhagic conversion) in patients who have suffered a significant interruption of blood flow to an area of brain (occlusion of large proximal cerebral artery) and have undergone successful removal of that interruption (revascularization).This will be achieved by comparing patients who have undergone hypothermia to those who have not.
Detailed Description
This study is designed to examine the safety and proof of concept of therapeutic hypothermia prior to conventional revascularization in subjects experiencing acute ischemic stroke by comparing the results to subjects who remain at normal body temperature (normothermic) and proceed directly to reperfusion via conventional reperfusion intervention. The investigational plan also examines the following outcomes in 85 subjects randomized to either hypothermia or normothermia: Regulation of biomarkers indicative of ischemia-reperfusion injury Changes in blood brain injury using the Hyperintense Acute Reperfusion Marker (HARM) protocol MRI as a surrogate imaging biomarker Incidence of hemorrhagic conversion post reperfusion Neurologic function at 90 days post acute ischemic stroke. The results of this study will be used to power a definitive phase III clinical trial evaluating the combination of hypothermia and revascularization versus reperfusion alone.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ischemic Stroke, Hypothermia
Keywords
Acute ischemic stroke, Mild hypothermia, Stroke, Hypothermia, Cerebral infarction, Ischemia, Cerebrovascular disorder, Brain disease, Central nervous system disease, Nervous system disease, Vascular disease, Cardiovascular disease, Brain infarction, Brain ischemia, Pathologic process, Body temperature change, Signs and symptoms

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Normothermia
Arm Type
Active Comparator
Arm Description
As part of standard of care, an interventional reperfusion procedure will be performed on all subjects using the Trevo Pro Retriever (Stryker), after which normothermia will attempt to keep core body temp between 38 and 36.5 degrees centigrade.
Arm Title
Mild hypothermia
Arm Type
Experimental
Arm Description
As part of standard of care, an interventional reperfusion procedure will be performed on all subjects using the Trevo Pro Retriever (Stryker). Subjects will also have a catheter placed in the femoral vein (Zoll Thermogard XP technology with the Quattro catheter) and temperature brought to 33 degrees centigrade as quickly as possible. They will stay in mild hypothermia for 12 hours, and then be rewarmed very slowly.
Intervention Type
Procedure
Intervention Name(s)
Normothermia
Other Intervention Name(s)
Clot retrieval, reperfusion
Intervention Description
Device: Trevo Pro Retriever (Stryker Corp.)
Intervention Type
Procedure
Intervention Name(s)
Mild hypothermia
Other Intervention Name(s)
Therapeutic hypothermia, clot retrieval, reperfusion
Intervention Description
Device: Zoll Thermogard XP technology with the Quattro catheter Device: Trevo Pro Retriever (Stryker Corp.)
Intervention Type
Device
Intervention Name(s)
Trevo Pro Retriever (Stryker Corp.)
Intervention Description
Device: Trevo Pro Retriever (Stryker Corp.)
Intervention Type
Device
Intervention Name(s)
Zoll Thermogard XP technology with the Quattro catheter
Intervention Description
Device: Zoll Thermogard XP technology with the Quattro catheter
Primary Outcome Measure Information:
Title
Hemorrhagic Conversion
Description
Acute bleeding into the area of the original stroke based on CT or MRI of the head.
Time Frame
48 hours
Secondary Outcome Measure Information:
Title
Hyperintense Acute Reperfusion Marker (HARM)
Description
HARM is a MRI sequence looking at gadolinium enhancement on FLAIR MRI imaging.
Time Frame
48 +/- 24 hours
Title
National Institutes of Health Stroke Scale (NIHSS)
Description
NIHSS is a scale from 1-42 to evaluate stroke severity
Time Frame
Baseline, 24 +/- 6 hours, 48 +/- 24 hours, 8 +/- 2 days, 90 +/- 15 days
Title
Modified Rankin Scale (mRS)
Description
mRS is a straightforward evaluation of the functional limitations from stroke
Time Frame
Basline, 48 +/- 24 hours, 90 +/- 15 days
Title
Number of participants with adverse events
Description
Evaluation and determination of the following complications pneumonias, central line infections, intra-cerebral hemorrhages, systemic hemorrhages, transient cerebral ischemia, and new strokes.
Time Frame
90 days

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
79 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female subjects of any ethnicity and age >/=18 but </= 79 years; Symptom onset </=8 hours; Symptoms consistent with an ischemic stroke with a large vessel occlusion (Middle Cerebral Artery (MCA), Internal Carotid Artery (ICA) terminus) as determined by CT imaging of the brain; Alberta Stroke Program Early CT Score (ASPECTS) of 5-10 on non-contrast CT of the brain; Ability to undergo endovascular reperfusion therapy; No contraindications to general anesthesia, conscious sedation, or allergies to any components associated with the anticipated diagnostic or treatment procedures that cannot be treated; A pre-treatment modified Rankin Scale (mRS) of 0 or 1; Baseline CT scan shows no hemorrhage; National Institutes of Health Stroke Scale (NIHSS) 14-29; Subject has either 1) failed iv tissue plasminogen activator (tPA) therapy or 2) contradicted for iv tPA therapy; Subject is capable of complying with study procedures and agrees to complete all required study procedures, study visits and associated activities. Subject or legally authorized representative must be able to understand and give written informed consent. Exclusion Criteria: Females of childbearing potential who are pregnant or not using adequate contraception; Bleeding diathesis with a platelet count < 50,000 or International Normalized Ratio (INR) >1.7 or any active or recent (within 10 to 30 days) hemorrhage; History of genetically confirmed hypercoagulable syndrome; Any condition that excludes MRI imaging; History of dementia, currently on Aricept or Namenda, or other Alzheimer's-like symptoms; End stage renal disease on hemodialysis; History of cardiac arrest; Presence of an inferior vena cava (IVC) filter; Contrast dye allergy with history of anaphylaxis, known serious sensitivity to contrast agents or any condition in which angiography is contraindicated; Known allergy to meperidine or buspar; Prior neurologic event that would obscure interpretation of the signal and current presenting neurologic deficits; Sustained hypertension (systolic blood pressure (SBP) > 185 or diastolic blood pressure (DBP) > 110 refractory to treatment); Baseline CT/MRI of head showing evidence of mass effect with mid-line shift, hemorrhage, intracranial tumor, arterial vasculitis or dissection, or bilateral stroke; Presence of any other serious comorbidity that would be likely to impact life expectancy to less than 6 months or limit subject cooperation or study compliance; Concurrent participation in an investigational clinical study that has not completed the follow-up period or planned participation in another study within the next 3 months; Any other condition or personal circumstance that, in the judgment of the investigator, might interfere with the collection of complete, good quality data or the completion of the research study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rishi Gupta, MD
Organizational Affiliation
WellStar Health System
Official's Role
Study Director
Facility Information:
Facility Name
WellStar Kennestone Regional Medical Center
City
Marietta
State/Province
Georgia
ZIP/Postal Code
30060
Country
United States

12. IPD Sharing Statement

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