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Cilostazol Dexborneol Versus Placebo for Microcirculation Dysfunction After Reperfusion Therapy in Patients With Acute Ischemic Stroke With Large Vessel Occlusion (CRYSTAL)

Primary Purpose

Acute Ischemic Stroke, Reperfusion, Large Vessel Occlusion

Status
Recruiting
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
Y-6 sublingual tablets
Placebo tablets of Y-6 sublingual tablet
Sponsored by
Beijing Tiantan Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Acute Ischemic Stroke focused on measuring microcirculation dysfunction, Y-6, cilostazol, dexborneol, Thrombo-inflammation, acute ischemic stroke, large vessel occlusion, reperfusion therapy, CRYSTAL

Eligibility Criteria

35 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion criteria: 35 years old ≤ Age ≤ 80 years old Patients with acute ischemic stroke was diagnosed within 24 hours of onset (time from onset to completion of reperfusion therapy) Patients with first stroke or prior to stroke onset (mRS score 0-1) Patients with acute large vessel occlusion (LVO) confirmed by imaging, including the responsible vessel was located in the intracranial internal carotid artery, the T-shaped branch, the M1/M2 segment of the middle cerebral artery, or the A1/A2 segment of the anterior cerebral artery ASPECTS score ≥ 6 6<NIHSS score ≤ 25 after the onset of this disease Patients who meet the indications for reperfusion therapy, including mechanical thrombectomy, bridging therapy (intravenous r-tPA thrombolytic therapy), and plan to undergo mechanical thrombectomy Patients or his/her legal representatives are able to understand and sign the informed consent Exclusion criteria: Severe consciousness disturbance: NIHSS 1a consciousness level ≥2 points Patients with definite history of intracranial hemorrhage (such as subarachnoid hemorrhage, cerebral hemorrhage, etc.) Patients with intracranial tumor, arteriovenous malformation, or aneurysm Patients with bilateral anterior or posterior circulation ischemic stroke Patients with large vascular occlusion of rare or unknown etiology, such as dissection, vasculitis, etc. Patients who have received treatment with dual antiplatelet drugs, tirofiban, warfarin, novel oral anticoagulant, argatroban, snake venom, defibrase, lumbrokinase and other defibrase therapy after the onset of disease Patients with severe hepatic insufficiency or renal insufficiency and received dialysis for various reasons before randomization (severe hepatic insufficiency is defined as ALT > 3 × ULN or AST >3 × ULN; severe renal insufficiency is defined as serum creatinine >3.0 mg/dL (265.2 μmol/L) or creatinine clearance < 30 mL/min) Patients with haemorrhagic diathesis (including but not limited to): platelet count < 100 × 109/L; heparin treatment within the last 48 hours; taking oral warfarin; taking novel oral anticoagulant; administration with direct thrombin or Xa factor inhibitors; with hereditary hemorrhagic disorders, such as hemophilia Patients with refractory hypertension that is difficult to be controlled by medication (systolic blood pressure > 180 mmHg or diastolic blood pressure > 110 mmHg) Patients with significant head trauma or stroke within 3 months prior to randomization Patients who have received intracranial or spinal surgery within 3 months prior to randomization Patients with history of major surgery or serious physical trauma within 1 month prior to randomization Patients with hemorrhagic retinopathy Male subjects (or their partners) or female subjects who had planned to have a child during the whole study period and within 3 months after the end of the study period or were unwilling to use one or more non-drug contraceptive methods (e.g., complete abstinence, condoms, ligation, etc.) during the study period Patients with contraindications to known contrast agent or other contrast agents; subjects who are allergic to cilostazol or dexborneol Patients who plan to receive other surgical or intervention therapy within 3 months, which might require discontinuation of the study drugs Patients with advanced disease, leading to life expectancy of < 6 months Patients who have received treatment of investigational drug or device within 3 months Other conditions where it is not suitable for patients to participate in the clinical trial, such as inability to understand and/or follow the study procedures and/or follow-up schedule due to psychiatric disorders or cognitive/emotional disorders, or contraindications to thrombectomy or MRI, etc.

Sites / Locations

  • Liuzhou Workers' HospitalRecruiting
  • Hunan Provincial People's HospitalRecruiting
  • Pingxiang people's hospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Y-6 sublingual tablets

Placebo tablets of Y-6 sublingual tablet

Arm Description

Y-6 sublingual tablets (each tablet contains 25 mg cilostazol and 6 mg dexborneol) Manufacturer: Nanjing Neurodawn Pharmaceutical Co., Ltd.

Y-6 strength: Placebo tablets of Y-6 sublingual tablet (each tablet contains 0 mg cilostazol and 0.06 mg dexborneol) Manufacturer: Nanjing Neurodawn Pharmaceutical Co., Ltd.

Outcomes

Primary Outcome Measures

Proportion of mRS score recovered to 0~1 score
The modified Rankin Scale (mRS) decreasing to 0~1 score. mRS Mainly measures patients' independent living ability, including physical function, activity ability and participation in daily life. A score of 0 on the mRS Scale indicates no symptoms and a score of 5 indicates severe disability.

Secondary Outcome Measures

The mRS score at 90±7 days after randomization
The modified Rankin Scale (mRS) evaluated at 90±7 days after randomization. mRS Mainly measures patients' independent living ability, including physical function, activity ability and participation in daily life. A score of 0 on the mRS Scale indicates no symptoms and a score of 5 indicates severe disability.
Integrity of BBB evaluated by DCE
BBB permeability is assessed by DCE-MRI
Changes of NIHSS score between baseline and immediately after reperfusion therapy
NIHSS score after reperfusion therapy within 2 hours changing compared with baseline NIHSS. The NIHSS score ranges from 0 to 42. The higher the score, the more severe the nerve damage.
Changes of NIHSS score between baseline and at 24 ± 2 hours, 96 ± 7 hours, 14 ± 2 days and 28 ± 3days after randomization
NIHSS score changing compared with baseline NIHSS. The NIHSS score ranges from 0 to 42. The higher the score, the more severe the nerve damage.
Proportion of study patients with early progression of stroke at 24 ± 2 hours and 96 ± 7 hours after randomization
NIHSS score increasing by ≥ 2 points, or the score of hemiplegia increasing by≥1 point, or the score of conscious disturbance increasing by ≥ 1 point compared with baseline within 7 days of onset, and intracranial hemorrhage is excepted by CT or MRI. Exacerbations not attributable to stroke are also excluded such as cardiac failure, liver and renal failure, etc.
Proportion of study patients with combined vascular events at 90 ± 7 days after randomization
Symptomatic stroke, myocardial infarction and vascular death

Full Information

First Posted
April 19, 2023
Last Updated
September 27, 2023
Sponsor
Beijing Tiantan Hospital
Collaborators
NeuroDawn Pharmaceutical Co., Ltd.
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1. Study Identification

Unique Protocol Identification Number
NCT05836766
Brief Title
Cilostazol Dexborneol Versus Placebo for Microcirculation Dysfunction After Reperfusion Therapy in Patients With Acute Ischemic Stroke With Large Vessel Occlusion
Acronym
CRYSTAL
Official Title
Cilostazol Dexborneol Versus Placebo for Microcirculation Dysfunction After Reperfusion Therapy in Patients With Acute Ischemic Stroke With Large Vessel Occlusion: A Phase Ⅱa,Prospective,Multicenter,Randomized, Double-blind,Placebo-controlled Parallel Trial
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 5, 2023 (Actual)
Primary Completion Date
July 2024 (Anticipated)
Study Completion Date
August 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Beijing Tiantan Hospital
Collaborators
NeuroDawn Pharmaceutical Co., Ltd.

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
This study aims to evaluate the efficacy of Y-6 sublingual tablets in improving microcirculation dysfunction and reducing thrombo-inflammation in patients who had AIS caused by LVO and received reperfusion therapy. Moreover, we expect to evaluate the safety of using Y-6 sublingual tablet in such study population.
Detailed Description
This study rationale is based on the following scheme: in patients with acute ischemic stroke caused by LVO, receiving reperfusion therapy may cause futile recanalization and thus lead to microcirculation dysfunction and thrombo-inflammation as consequences. Cilostazol has antiplatelet effects and BBB protection and Dexborneol has anti-inflammatory effects; therefore, the multi-component tablet may exert neuroprotective effects in terms of improving microcirculation dysfunction and reducing thrombo-inflammation in patients with AIS after reperfusion therapy. The primary purpose of this study is to investigate the proportion of modified-Rankin scale (mRS) score recovered to 0~1 score at 90±7 days after randomization. The follow-up duration is 3 months, and the visit schedule is as follows: Subjects enrolled based on randomization procedures will receive visits at screening/baseline period, first drug administration, immediately after reperfusion therapy(within 2 hours), 24 ± 2 hours, 96 ± 7 hours, 14 ± 2 days, 28 ± 2 days and 90 ± 7 days after randomization, and in case of any events.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Ischemic Stroke, Reperfusion, Large Vessel Occlusion
Keywords
microcirculation dysfunction, Y-6, cilostazol, dexborneol, Thrombo-inflammation, acute ischemic stroke, large vessel occlusion, reperfusion therapy, CRYSTAL

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
120 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Y-6 sublingual tablets
Arm Type
Active Comparator
Arm Description
Y-6 sublingual tablets (each tablet contains 25 mg cilostazol and 6 mg dexborneol) Manufacturer: Nanjing Neurodawn Pharmaceutical Co., Ltd.
Arm Title
Placebo tablets of Y-6 sublingual tablet
Arm Type
Placebo Comparator
Arm Description
Y-6 strength: Placebo tablets of Y-6 sublingual tablet (each tablet contains 0 mg cilostazol and 0.06 mg dexborneol) Manufacturer: Nanjing Neurodawn Pharmaceutical Co., Ltd.
Intervention Type
Drug
Intervention Name(s)
Y-6 sublingual tablets
Intervention Description
Take Y-6 sublingual tablets for 28 days continuously.
Intervention Type
Drug
Intervention Name(s)
Placebo tablets of Y-6 sublingual tablet
Intervention Description
Take Placebo tablets of Y-6 sublingual tablet for 28 days continuously.
Primary Outcome Measure Information:
Title
Proportion of mRS score recovered to 0~1 score
Description
The modified Rankin Scale (mRS) decreasing to 0~1 score. mRS Mainly measures patients' independent living ability, including physical function, activity ability and participation in daily life. A score of 0 on the mRS Scale indicates no symptoms and a score of 5 indicates severe disability.
Time Frame
90±7 days after randomization
Secondary Outcome Measure Information:
Title
The mRS score at 90±7 days after randomization
Description
The modified Rankin Scale (mRS) evaluated at 90±7 days after randomization. mRS Mainly measures patients' independent living ability, including physical function, activity ability and participation in daily life. A score of 0 on the mRS Scale indicates no symptoms and a score of 5 indicates severe disability.
Time Frame
90±7 days after randomization
Title
Integrity of BBB evaluated by DCE
Description
BBB permeability is assessed by DCE-MRI
Time Frame
96±7 hours after randomization
Title
Changes of NIHSS score between baseline and immediately after reperfusion therapy
Description
NIHSS score after reperfusion therapy within 2 hours changing compared with baseline NIHSS. The NIHSS score ranges from 0 to 42. The higher the score, the more severe the nerve damage.
Time Frame
immediately after reperfusion therapy (within 2 hours)
Title
Changes of NIHSS score between baseline and at 24 ± 2 hours, 96 ± 7 hours, 14 ± 2 days and 28 ± 3days after randomization
Description
NIHSS score changing compared with baseline NIHSS. The NIHSS score ranges from 0 to 42. The higher the score, the more severe the nerve damage.
Time Frame
24 ± 2 hours, 96 ± 7 hours, 14 ± 2 days and 28 ± 3 days after randomization and baseline NIHSS score
Title
Proportion of study patients with early progression of stroke at 24 ± 2 hours and 96 ± 7 hours after randomization
Description
NIHSS score increasing by ≥ 2 points, or the score of hemiplegia increasing by≥1 point, or the score of conscious disturbance increasing by ≥ 1 point compared with baseline within 7 days of onset, and intracranial hemorrhage is excepted by CT or MRI. Exacerbations not attributable to stroke are also excluded such as cardiac failure, liver and renal failure, etc.
Time Frame
24 ± 2 hours and 96 ± 7 hours after randomization
Title
Proportion of study patients with combined vascular events at 90 ± 7 days after randomization
Description
Symptomatic stroke, myocardial infarction and vascular death
Time Frame
90 ± 7 days after randomization
Other Pre-specified Outcome Measures:
Title
Integrity evaluation of BBB by FEXI at 96 ± 7 hours after randomization
Description
BBB permeability is assessed by FEXI
Time Frame
96 ± 7 hours after randomization
Title
Integrity evaluation of BBB by FEXI at 28 ± 3 days after randomization
Description
BBB permeability is assessed by FEXI
Time Frame
28 ± 3 days after randomization
Title
Differences of indicators of venous thrombotic inflammation (plasma sGPVI, sADAMTS 13, sCD40L levels) and indirect indicators of BBB disruption (MMP-9, S100B) between baseline and 14±2 days of randomization
Description
Collecting blood samples to evaluate venous thrombotic inflammation (plasma sGPVI, sADAMTS 13, sCD40L levels) and indirect indicators of blood-brain barrier disruption (MMP-9, S100B)
Time Frame
14±2 days of randomization compared with baseline
Title
Differences of indicators of venous thrombotic inflammation (plasma sGPVI, sADAMTS 13, sCD40L levels) and indirect indicators of BBB disruption (MMP-9, S100B) between baseline and 24±2 hours of randomization
Description
Collecting blood samples to evaluate venous thrombotic inflammation (plasma sGPVI, sADAMTS 13, sCD40L levels) and indirect indicators of blood-brain barrier disruption (MMP-9, S100B)
Time Frame
24±2 hours of randomization compared with baseline

10. Eligibility

Sex
All
Minimum Age & Unit of Time
35 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion criteria: 35 years old ≤ Age ≤ 80 years old Patients with acute ischemic stroke was diagnosed within 24 hours of onset (time from onset to completion of reperfusion therapy) Patients with first stroke or prior to stroke onset (mRS score 0-1) Patients with acute large vessel occlusion (LVO) confirmed by imaging, including the responsible vessel was located in the intracranial internal carotid artery, the T-shaped branch, the M1/M2 segment of the middle cerebral artery, or the A1/A2 segment of the anterior cerebral artery ASPECTS score ≥ 6 6<NIHSS score ≤ 25 after the onset of this disease Patients who meet the indications for reperfusion therapy, including mechanical thrombectomy, bridging therapy (intravenous r-tPA thrombolytic therapy), and plan to undergo mechanical thrombectomy Patients or his/her legal representatives are able to understand and sign the informed consent Exclusion criteria: Severe consciousness disturbance: NIHSS 1a consciousness level ≥2 points Patients with definite history of intracranial hemorrhage (such as subarachnoid hemorrhage, cerebral hemorrhage, etc.) Patients with intracranial tumor, arteriovenous malformation, or aneurysm Patients with bilateral anterior or posterior circulation ischemic stroke Patients with large vascular occlusion of rare or unknown etiology, such as dissection, vasculitis, etc. Patients who have received treatment with dual antiplatelet drugs, tirofiban, warfarin, novel oral anticoagulant, argatroban, snake venom, defibrase, lumbrokinase and other defibrase therapy after the onset of disease Patients with severe hepatic insufficiency or renal insufficiency and received dialysis for various reasons before randomization (severe hepatic insufficiency is defined as ALT > 3 × ULN or AST >3 × ULN; severe renal insufficiency is defined as serum creatinine >3.0 mg/dL (265.2 μmol/L) or creatinine clearance < 30 mL/min) Patients with haemorrhagic diathesis (including but not limited to): platelet count < 100 × 109/L; heparin treatment within the last 48 hours; taking oral warfarin; taking novel oral anticoagulant; administration with direct thrombin or Xa factor inhibitors; with hereditary hemorrhagic disorders, such as hemophilia Patients with refractory hypertension that is difficult to be controlled by medication (systolic blood pressure > 180 mmHg or diastolic blood pressure > 110 mmHg) Patients with significant head trauma or stroke within 3 months prior to randomization Patients who have received intracranial or spinal surgery within 3 months prior to randomization Patients with history of major surgery or serious physical trauma within 1 month prior to randomization Patients with hemorrhagic retinopathy Male subjects (or their partners) or female subjects who had planned to have a child during the whole study period and within 3 months after the end of the study period or were unwilling to use one or more non-drug contraceptive methods (e.g., complete abstinence, condoms, ligation, etc.) during the study period Patients with contraindications to known contrast agent or other contrast agents; subjects who are allergic to cilostazol or dexborneol Patients who plan to receive other surgical or intervention therapy within 3 months, which might require discontinuation of the study drugs Patients with advanced disease, leading to life expectancy of < 6 months Patients who have received treatment of investigational drug or device within 3 months Other conditions where it is not suitable for patients to participate in the clinical trial, such as inability to understand and/or follow the study procedures and/or follow-up schedule due to psychiatric disorders or cognitive/emotional disorders, or contraindications to thrombectomy or MRI, etc.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Yilong Wang, PhD,MD
Phone
0086-010-67092222
Ext
0
Email
yilong528@aliyun.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yilong Wang, PhD,MD
Organizational Affiliation
Beijing Tiantan Hospital, Capital Medical University, Beijing, China
Official's Role
Principal Investigator
Facility Information:
Facility Name
Liuzhou Workers' Hospital
City
Liuzhou
State/Province
Guangxi
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Yang Hong
Email
13768341368@139.com
Facility Name
Hunan Provincial People's Hospital
City
Changsha
State/Province
Hunan
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Zhao Zhihong
Email
1019200187@qq.com
Facility Name
Pingxiang people's hospital
City
Pingxiang
State/Province
Jiangxi
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Yi Fei
Email
yf8500@126.com

12. IPD Sharing Statement

Plan to Share IPD
No
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Cilostazol Dexborneol Versus Placebo for Microcirculation Dysfunction After Reperfusion Therapy in Patients With Acute Ischemic Stroke With Large Vessel Occlusion

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