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CHemical OptImization of Cerebral Embolectomy 2 (CHOICE 2). (CHOICE2)

Primary Purpose

Stroke, Acute Ischemic, Stroke, Acute

Status
Not yet recruiting
Phase
Phase 3
Locations
Spain
Study Type
Interventional
Intervention
Intraarterial alteplase
Sponsored by
Hospital Clinic of Barcelona
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Stroke, Acute Ischemic focused on measuring Mechanical Thrombectomy, Recanalization, Reperfusion, Alteplase

Eligibility Criteria

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

Inclusion Criteria: Patients with symptomatic large vessel occlusion (LVO) in the anterior circulation (ICA, ACA or MCA) treated with MT resulting in a mTICI score 2b/3 at end of the procedure. Patients with a mTICI score 2b/3 on the diagnostic cerebral angiography before the onset of MT are also eligible for the study. Estimated delay to onset of rescue intraarterial rt-PA administration <24 hours from symptom onset, defined as the point in time the patient was last seen well. No significant pre-stroke functional disability (modified Rankin scale 0-1), or mRS >1 that according to the investigator is not related to neurological disease (i.e., amputation, blindness) Age ≥18 ASPECTS >6 on non-contrast CT (NCCT) scan if symptoms lasting <4.5 hours of last seen well. In patients with >4.5h of last seen well, a CT-perfusion (Flow maps) or MRI-perfusion should be considered instead of NCCT, especially if >9h have elapsed, or in seriously ill patients (i.e., NIHSS>17). Nonetheless, if a perfusion study is not available, NCCT can still be used as long as it is confirmed without a doubt that the ASPECTS is > 6. Informed consent, obtained from patient or acceptable patient surrogate, or Differed Informed Consent (DIC) to avoid any delay in the initiation of the mechanical thrombectomy and the i.a thrombolysis. The DIC will be signed by the patient or acceptable patient surrogate at any time after the tPA treatment is started. Exclusion Criteria: NIHSS score on admission >25 Contraindication to IV t-PA as per local national guidelines (except time to therapy) Use of carotid artery stents during the endovascular procedure requiring dual antiplatelet therapy during the first 24h Need of more than 3 passes (per vessel) or more than a total of 5 passes (in more than one vessel) to complete the endovascular procedure Female who is pregnant or lactating or has a positive pregnancy test at time of admission Current participation in another investigation drug or device treatment study Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency Known coagulopathy, INR > 1.7 Platelets < 50,000 Renal Failure as defined by a serum creatinine > 3.0 mg/dl (or 265.2 μmol/l) or glomerular Filtration Rate [GFR] < 30 Subject who requires hemodialysis or peritoneal dialysis, or who have a contraindication to an angiogram for whatever reason Any hemorrhage on CT/MRI Clinical presentation suggests a subarachnoid hemorrhage, even if initial CT or MRI scan is normal Suspicion of aortic dissection Subject currently uses or has a recent history of illicit drug(s) or abuses alcohol History of life-threatening allergy (more than rash) to contrast medium SBP >185 mmHg or DBP >110 mmHg refractory to treatment Serious, advanced, terminal illness with anticipated life expectancy < 6 months Pre-existing neurological or psychiatric disease that would confound evaluation Presumed vasculitis or septic embolization Unlikely to be available for 90-day follow-up (i.e., no fixed home address, visitor from overseas)

Sites / Locations

  • Hospital Germans Trías i Pujol
  • Hospital Clinic Barcelona
  • Hospital de la Santa Creu i Sant Pau
  • Hospital del Mar
  • Hospital Universitario de Cruces
  • Hospital Universitario de A Coruña
  • Hospital Josep Trueta
  • Hospital Universitario Virgen de la Arrixaca
  • Hospital Universitario Central de Asturias
  • Hospital Universitario de Donostia
  • Hospital Univesitario y Politénico La Fe
  • Hospital Universitario de Valladolid

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

Intraarterial alteplase

No intervention

Arm Description

All the patients will be given a 15 minutes IA infusion of alteplase (Actylise®) at a drug concentration of 1.0 mg/ml. At 15 minutes of IA treatment onset, the infusion will be stopped and the angiographic score assessed. Study drug will be prepared according to the following steps: 1/ Dilute 2 vials of 10 mgs (rt-PA) in 20 cc of sterile water for injection (SWI), to attain a 20 ml solution at a concentration of 1mg/ml; 2. Calculate the volume of cc of infusion and therefore the total dose as per the formula: (Patient's weight in Kgs multiplied by 0.225). A patient of 89 Kgs or more will receive 20.0 cc of infusion for 15 min, totaling a dose of 20.0 mg of rt-PA.

Patients allocated to this arm will receive a similar care to patients allocated to IA alteplase except the thrombolytic

Outcomes

Primary Outcome Measures

Microvascular hypoperfusion on brain CT Perfusion
Proportion of patients with abnormal microvascular hypoperfusion on brain CTPerfusion at 36±24hours post Mechanical Thrombectomy.

Secondary Outcome Measures

modified Rankin Scale (mRS) score
Proportion of patients with a mRS 0 to 1 (min value 0, max value 6, higher score worse outcome)
Volume of microvascular hypoperfusion on follow-up brain CTP
Volume of hypoperfusion on brain CTP at 36h±24hours post MT
Infarct Expansion Ratio (IER): Final infarct to initial ischemic tissue volumes on brain CTP
Infarct Expansion Ratio (IER): Final infarct to initial ischemic tissue volumes on brain CTP at 36±24hours post MT.
Barthel Scale score
Barthel Scale score of 95 to 100, (min value 0, max value 100, higher score better outcome)
EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D-3L)
Quality of life measured with the EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D-3L) The score has five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, and extreme problems.
Shift analysis of the modified Rankin Scale (mRS)
Shift analysis of the modified Rankin Scale (mRS), at day 90 (min value 0, max value 6, higher score worse outcome)

Full Information

First Posted
March 9, 2023
Last Updated
March 21, 2023
Sponsor
Hospital Clinic of Barcelona
Collaborators
Instituto de Salud Carlos III, Fundacion Clinic per a la Recerca Biomédica
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1. Study Identification

Unique Protocol Identification Number
NCT05797792
Brief Title
CHemical OptImization of Cerebral Embolectomy 2 (CHOICE 2).
Acronym
CHOICE2
Official Title
CHemical OptImization of Cerebral Embolectomy in Patients With Acute Stroke Treated With Mechanical Thrombectomy 2 (CHOICE 2 TRIAL)
Study Type
Interventional

2. Study Status

Record Verification Date
March 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
June 1, 2023 (Anticipated)
Primary Completion Date
March 1, 2025 (Anticipated)
Study Completion Date
May 1, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Hospital Clinic of Barcelona
Collaborators
Instituto de Salud Carlos III, Fundacion Clinic per a la Recerca Biomédica

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Multi-center, randomized, parallel-group, superiority study to compare the efficacy of adjunct intra-arterial rt-PA versus not adjunct intra-arterial rt-PA in the improvement of the efficacy of mechanical thrombectomy in patients with large vessel occlusion acute ischemic stroke.
Detailed Description
The study objective is to validate whether the administration of intra-arterial rt-PA is efficient as an add-on to mechanical thrombectomy in patients with acute ischemic stroke and complete or near-complete recanalization of a proximal vessel occlusion and successful brain reperfusion on cerebral angiogram (corresponding to modified treatment in cerebral infarct (mTICI) score 2b/3). Patients with symptomatic large vessel occlusion (LVO) in the anterior circulation treated with MT resulting in a mTICI score 2b/3 on cerebral angiography will be enrolled in the angiosuite by interventionalists or neurologists once a mTICI 2b/3 is confirmed on cerebral angiography. Each included patient will be followed up to 90 days from the stroke. The primary outcome is the proportion of patients with microvascular hypoperfusion on CT Perfusion at 36±24h. The key secondary outcome is the proportion of patients with a mRS 0 to 1 at 90 days

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Stroke, Acute Ischemic, Stroke, Acute
Keywords
Mechanical Thrombectomy, Recanalization, Reperfusion, Alteplase

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Model Description
Multicenter, prospective, randomized, open, blinded end-point assessment phase III trial
Masking
Outcomes Assessor
Masking Description
The evaluation of the primary outcome measure (microvascular hypoperfusion on CTP) will be conducted at the Imaging Central Core Laboratory by blinded evaluators. The evaluation of key clinical outcome at 3 months will be conducted by central blinded evaluators following a structured questionnaire of the modified Rankin Scale (mRS
Allocation
Randomized
Enrollment
440 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Intraarterial alteplase
Arm Type
Experimental
Arm Description
All the patients will be given a 15 minutes IA infusion of alteplase (Actylise®) at a drug concentration of 1.0 mg/ml. At 15 minutes of IA treatment onset, the infusion will be stopped and the angiographic score assessed. Study drug will be prepared according to the following steps: 1/ Dilute 2 vials of 10 mgs (rt-PA) in 20 cc of sterile water for injection (SWI), to attain a 20 ml solution at a concentration of 1mg/ml; 2. Calculate the volume of cc of infusion and therefore the total dose as per the formula: (Patient's weight in Kgs multiplied by 0.225). A patient of 89 Kgs or more will receive 20.0 cc of infusion for 15 min, totaling a dose of 20.0 mg of rt-PA.
Arm Title
No intervention
Arm Type
No Intervention
Arm Description
Patients allocated to this arm will receive a similar care to patients allocated to IA alteplase except the thrombolytic
Intervention Type
Drug
Intervention Name(s)
Intraarterial alteplase
Other Intervention Name(s)
Intraarterial recombinant tissue plasminogen activator (rt-PA)
Intervention Description
See arm/group descriptions.
Primary Outcome Measure Information:
Title
Microvascular hypoperfusion on brain CT Perfusion
Description
Proportion of patients with abnormal microvascular hypoperfusion on brain CTPerfusion at 36±24hours post Mechanical Thrombectomy.
Time Frame
36±24hours post treatment
Secondary Outcome Measure Information:
Title
modified Rankin Scale (mRS) score
Description
Proportion of patients with a mRS 0 to 1 (min value 0, max value 6, higher score worse outcome)
Time Frame
90 days post MT
Title
Volume of microvascular hypoperfusion on follow-up brain CTP
Description
Volume of hypoperfusion on brain CTP at 36h±24hours post MT
Time Frame
36±24hours post treatment
Title
Infarct Expansion Ratio (IER): Final infarct to initial ischemic tissue volumes on brain CTP
Description
Infarct Expansion Ratio (IER): Final infarct to initial ischemic tissue volumes on brain CTP at 36±24hours post MT.
Time Frame
36±24hours post treatment
Title
Barthel Scale score
Description
Barthel Scale score of 95 to 100, (min value 0, max value 100, higher score better outcome)
Time Frame
day 90 post treatment
Title
EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D-3L)
Description
Quality of life measured with the EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D-3L) The score has five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 3 levels: no problems, some problems, and extreme problems.
Time Frame
day 90 post treatment
Title
Shift analysis of the modified Rankin Scale (mRS)
Description
Shift analysis of the modified Rankin Scale (mRS), at day 90 (min value 0, max value 6, higher score worse outcome)
Time Frame
day 90 post treatment
Other Pre-specified Outcome Measures:
Title
SAFETY OUTCOME: Mortality at 90 days
Description
Mortality at 90 days
Time Frame
Day 90
Title
SAFETY OUTCOME: symptomatic intracerebral hemorrahge (sICH ) rate at 24 hours.
Description
Symptomatic ICH will be classified as per the European Cooperative Acute Stroke Study (ECASS) 3 criteria
Time Frame
24hours post MT

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients with symptomatic large vessel occlusion (LVO) in the anterior circulation (ICA, ACA or MCA) treated with MT resulting in a mTICI score 2b/3 at end of the procedure. Patients with a mTICI score 2b/3 on the diagnostic cerebral angiography before the onset of MT are also eligible for the study. Estimated delay to onset of rescue intraarterial rt-PA administration <24 hours from symptom onset, defined as the point in time the patient was last seen well. No significant pre-stroke functional disability (modified Rankin scale 0-1), or mRS >1 that according to the investigator is not related to neurological disease (i.e., amputation, blindness) Age ≥18 ASPECTS >6 on non-contrast CT (NCCT) scan if symptoms lasting <4.5 hours of last seen well. In patients with >4.5h of last seen well, a CT-perfusion (Flow maps) or MRI-perfusion should be considered instead of NCCT, especially if >9h have elapsed, or in seriously ill patients (i.e., NIHSS>17). Nonetheless, if a perfusion study is not available, NCCT can still be used as long as it is confirmed without a doubt that the ASPECTS is > 6. Informed consent, obtained from patient or acceptable patient surrogate, or Differed Informed Consent (DIC) to avoid any delay in the initiation of the mechanical thrombectomy and the i.a thrombolysis. The DIC will be signed by the patient or acceptable patient surrogate at any time after the tPA treatment is started. Exclusion Criteria: NIHSS score on admission >25 Contraindication to IV t-PA as per local national guidelines (except time to therapy) Use of carotid artery stents during the endovascular procedure requiring dual antiplatelet therapy during the first 24h Need of more than 3 passes (per vessel) or more than a total of 5 passes (in more than one vessel) to complete the endovascular procedure Female who is pregnant or lactating or has a positive pregnancy test at time of admission Current participation in another investigation drug or device treatment study Known hereditary or acquired hemorrhagic diathesis, coagulation factor deficiency Known coagulopathy, INR > 1.7 Platelets < 50,000 Renal Failure as defined by a serum creatinine > 3.0 mg/dl (or 265.2 μmol/l) or glomerular Filtration Rate [GFR] < 30 Subject who requires hemodialysis or peritoneal dialysis, or who have a contraindication to an angiogram for whatever reason Any hemorrhage on CT/MRI Clinical presentation suggests a subarachnoid hemorrhage, even if initial CT or MRI scan is normal Suspicion of aortic dissection Subject currently uses or has a recent history of illicit drug(s) or abuses alcohol History of life-threatening allergy (more than rash) to contrast medium SBP >185 mmHg or DBP >110 mmHg refractory to treatment Serious, advanced, terminal illness with anticipated life expectancy < 6 months Pre-existing neurological or psychiatric disease that would confound evaluation Presumed vasculitis or septic embolization Unlikely to be available for 90-day follow-up (i.e., no fixed home address, visitor from overseas)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Martha Vargas, PhD
Phone
0034-93 227 54 00
Ext
2118
Email
mvargas@clinic.cat
First Name & Middle Initial & Last Name or Official Title & Degree
Arturo Renú, MD
Phone
0034-93 227 54 00
Ext
2118
Email
arenu@clinic.cat
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Angel Chamorro, MD
Organizational Affiliation
Comprehensive Stroke Center, Hospital Clinic Barcelona
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Arturo Renú, MD
Organizational Affiliation
Comprehensive Stroke Center, Hospital Clinic Barcelona
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Juan F Arenillas, MD
Organizational Affiliation
Hospital Universitario de Valladolid
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
María del Mar Freijo, MD
Organizational Affiliation
Hospital Universitario de Cruces
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Maite Alonso, MD
Organizational Affiliation
Hospital Universitario de Donostia
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
María D Fernandez, MD
Organizational Affiliation
Hospital Universitario de A Coruña
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Pedro Vega, MD
Organizational Affiliation
Hospital Universitario Central de Asturias
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Lluis Morales, MD
Organizational Affiliation
Hospital Univesitario y Politénico La Fe
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Laura Dorado, MD
Organizational Affiliation
Hospital Germans Trías i Pujol
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Pol Camps, MD
Organizational Affiliation
Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Mikel Terceño, MD
Organizational Affiliation
Hospital Josep Trueta
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Ana Morales, MD
Organizational Affiliation
Hospital Universitario Virgen de la Arrixaca
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Elisa Cuadrado, MD
Organizational Affiliation
Hospital del Mar
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hospital Germans Trías i Pujol
City
Badalona
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Laura Dorado, MD
Phone
934 65 12 00
Email
ldorado.germanstrias@gencat.cat
Facility Name
Hospital Clinic Barcelona
City
Barcelona
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Arturo Renu, MD
Phone
932275414
Ext
5414
Email
arenu@clinic.cat
Facility Name
Hospital de la Santa Creu i Sant Pau
City
Barcelona
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Pol Camps, MD
Phone
935 53 71 45
Email
PCamps@santpau.cat
Facility Name
Hospital del Mar
City
Barcelona
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Elisa Cuadrado
Phone
932 48 30 00
Email
ecuadrado@psmar.cat
Facility Name
Hospital Universitario de Cruces
City
Bilbao
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
María del Mar Freijo, MD
Phone
946 00 60 00
Email
MARIADELMAR.FREIJOGUERRERO@osakidetza.eus
Facility Name
Hospital Universitario de A Coruña
City
Coruña
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
María D Fernandez, MD
Phone
981 17 80 00
Email
ma.dolores.fernandez.couto@sergas.es
Facility Name
Hospital Josep Trueta
City
Girona
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Mikel Terceño
Phone
972 94 02 00
Email
mikelterceno@hotmail.com
Facility Name
Hospital Universitario Virgen de la Arrixaca
City
Murcia
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Ana Morales, MD
Phone
968 36 95 00
Email
amoralesortiz@gmail.com
Facility Name
Hospital Universitario Central de Asturias
City
Oviedo
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Pedro Vega, MD
Phone
985 10 80 00
Email
peveval@yahoo.es
Facility Name
Hospital Universitario de Donostia
City
San Sebastián
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Maitane Alonso, MD
Phone
943 00 70 00
Email
malonsolacabe@gmail.com
Facility Name
Hospital Univesitario y Politénico La Fe
City
Valencia
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lluis Morales, MD
Phone
961 24 40 00
Email
lluismoralescaba@gmail.com
Facility Name
Hospital Universitario de Valladolid
City
Valladolid
Country
Spain
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Juan F Arenillas, MD
Phone
983 42 00 00
Email
juanfrancisco.arenillas@uva.es

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Deidentified individual participant data on outcome measures will be published along with the main results of the trial.
IPD Sharing Time Frame
The data will become available after publication of main study results.
IPD Sharing Access Criteria
The IPD will be available from the Sponsor of the trial on reasonable request.
Citations:
PubMed Identifier
28912596
Citation
Chamorro A, Blasco J, Lopez A, Amaro S, Roman LS, Llull L, Renu A, Rudilosso S, Laredo C, Obach V, Urra X, Planas AM, Leira EC, Macho J. Complete reperfusion is required for maximal benefits of mechanical thrombectomy in stroke patients. Sci Rep. 2017 Sep 14;7(1):11636. doi: 10.1038/s41598-017-11946-y.
Results Reference
background
PubMed Identifier
28318984
Citation
Davalos A, Cobo E, Molina CA, Chamorro A, de Miquel MA, Roman LS, Serena J, Lopez-Cancio E, Ribo M, Millan M, Urra X, Cardona P, Tomasello A, Castano C, Blasco J, Aja L, Rubiera M, Gomis M, Renu A, Lara B, Marti-Fabregas J, Jankowitz B, Cerda N, Jovin TG; REVASCAT Trial Investigators. Safety and efficacy of thrombectomy in acute ischaemic stroke (REVASCAT): 1-year follow-up of a randomised open-label trial. Lancet Neurol. 2017 May;16(5):369-376. doi: 10.1016/S1474-4422(17)30047-9. Epub 2017 Mar 16.
Results Reference
background
PubMed Identifier
25882510
Citation
Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Roman L, Serena J, Abilleira S, Ribo M, Millan M, Urra X, Cardona P, Lopez-Cancio E, Tomasello A, Castano C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Perez M, Goyal M, Demchuk AM, von Kummer R, Gallofre M, Davalos A; REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015 Jun 11;372(24):2296-306. doi: 10.1056/NEJMoa1503780. Epub 2015 Apr 17.
Results Reference
background
PubMed Identifier
31852410
Citation
Renu A, Blasco J, Millan M, Marti-Fabregas J, Cardona P, Oleaga L, Macho J, Molina C, Roquer J, Amaro S, Davalos A, Zarco F, Laredo C, Tomasello A, Guimaraens L, Barranco R, Castano C, Vivas E, Ramos A, Lopez-Rueda A, Urra X, Muchada M, Cuadrado-Godia E, Camps-Renom P, Roman LS, Rios J, Leira EC, Jovin T, Torres F, Chamorro A; CHOICE Investigators. The Chemical Optimization of Cerebral Embolectomy trial: Study protocol. Int J Stroke. 2021 Jan;16(1):110-116. doi: 10.1177/1747493019895656. Epub 2019 Dec 18.
Results Reference
background
PubMed Identifier
35143603
Citation
Renu A, Millan M, San Roman L, Blasco J, Marti-Fabregas J, Terceno M, Amaro S, Serena J, Urra X, Laredo C, Barranco R, Camps-Renom P, Zarco F, Oleaga L, Cardona P, Castano C, Macho J, Cuadrado-Godia E, Vivas E, Lopez-Rueda A, Guimaraens L, Ramos-Pachon A, Roquer J, Muchada M, Tomasello A, Davalos A, Torres F, Chamorro A; CHOICE Investigators. Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial. JAMA. 2022 Mar 1;327(9):826-835. doi: 10.1001/jama.2022.1645.
Results Reference
background
PubMed Identifier
36054449
Citation
Laredo C, Rodriguez A, Oleaga L, Hernandez-Perez M, Renu A, Puig J, Roman LS, Planas AM, Urra X, Chamorro A. Adjunct Thrombolysis Enhances Brain Reperfusion following Successful Thrombectomy. Ann Neurol. 2022 Nov;92(5):860-870. doi: 10.1002/ana.26474. Epub 2022 Aug 23.
Results Reference
background
PubMed Identifier
35763000
Citation
Chamorro A, Torres F. Intra-arterial Alteplase vs Placebo After Successful Thrombectomy and Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke-Reply. JAMA. 2022 Jun 28;327(24):2456. doi: 10.1001/jama.2022.7430. No abstract available.
Results Reference
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CHemical OptImization of Cerebral Embolectomy 2 (CHOICE 2).

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