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Resuvastatin Treatment for Symptomatic Middle Cerebral Artery Stenosis Based on High-resolution Magnetic Resonance Imaging (REALM)

Primary Purpose

Intracranial Arterial Stenosis

Status
Completed
Phase
Phase 4
Locations
China
Study Type
Interventional
Intervention
Rosuvastatin
Sponsored by
Beijing Tiantan Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Intracranial Arterial Stenosis

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or female patients between 18 and 75 years of age.
  2. Ischemic stroke originate from middle cerebral artery(MCA) AS stenosis, stroke onset within 1 month.
  3. LDL-C level is more than 70mg/dl (1.8mmol/L), but less than 250mg/dl (6.5mmol/L); and triglyceride level is less than 353mg/dl (4.0mmol/L).
  4. total term of statin therapy less than 2 month in past 1year before entering the study.

(5)30-70% intracranial artery stenosis in M1 segment of MCA comfirmed by CTA or MRI at least 1 or more atherosclerotic plaques in M1 segment of MCA is detectable.

(6)Female patients must agree to use an effective form of birth control throughout the 2-year study treatment period.

(7)The patients who are willing to be enrolled have to remain on the low cholesterol dietary for the study duration.

(8)The patient must be able to comply with scheduled visits, the treatment plan and all laboratory tests.

(9)Written informed consent is provided to participate in the study.

Exclusion Criteria:

  1. Any hemorrhagic stroke or hemorrhagic infarction
  2. Presence of any of cardiac sources of embolism
  3. Ischemic stroke caused by non MCA stenosis
  4. The patients has LDL cholesterol ≤ 70mg/dl or familial hypercholesterolemia.
  5. Previous treatment of target lesion with a stent, angioplasty, or other mechanical device, or plan to perform staged angioplasty within 2 years
  6. Any aneurysm proximal to or distal to stenotic intracranial artery
  7. Intracranial tumor (except meningioma) or any intracranial vascular malformation
  8. Thrombolytic therapy within 24 hours before enrollmentnt
  9. The patient has plans for surgical/endovascular intervention for intracranial, carotid, coronary and/or peripheral arterial disease during the course of the study.
  10. The patient has or is being treated or evaluated for diagnosed tuberculosis.
  11. The patient has a history of malignant neoplasm within the previous 5 years (exception: curable non-melanoma skin malignancies).
  12. The patient has a known immunodeficient state (e.g., human immunodeficiency virus) or is being treated with immunosuppressive drugs including cyclosporine.
  13. The patient has any other clinically significant medical condition that, in the opinion of the Investigator, could impact the patient's ability to successfully complete the trial.
  14. Life expectancy of patients is less than 2 years.
  15. The patient have to take medicines as follow: Hormonal therapy, Cyclosporine and other lipid lowering agents: fish oil, garlic essential oil etc.
  16. The patient has a history of recent alcohol abuse, drug abuse or significant mental illness.
  17. The patient has any condition that would prevent the patient from giving voluntary informed consent.
  18. The patient has an inability to tolerate oral medication administration.
  19. The patient has a known or suspected allergy to the study medication(s) or the class of study medication to be administered.
  20. The patients cannot finish HR-MRI for any reasons.
  21. Pregnancy or of childbearing potential and unwilling to use contraception for the duration of this study
  22. The patient is enrolled or plans to enroll in another clinical drug or device/interventional trial during this study.
  23. The patient has the history of epilepsy/seizures.
  24. The patient has liver function tests > 1.5 times the upper limit of normal, serum creatinine > 2.0 mg/dL, GFR < 30 ml/min or has abnormal laboratory values which are deemed clinically significant by the investigator.
  25. The patient has the history of myopathy.
  26. The patient has thyroid stimulating hormone > 1.5xULN.
  27. BMI ≥ 30 kg/m2

Sites / Locations

  • Beijing Tiantan Hospital affliated to Capital Medical University

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

Rosuvastatin

Arm Description

Outcomes

Primary Outcome Measures

The change in the percentage of volume of MCA atherosclerosis plaque after 2 years treatment of Rosuvastatin 10-20mg

Secondary Outcome Measures

The change in Percentage of plaque volume of M1segment plaque
The change in Percentage of lumen volume
The change in percentage of lipid rich necrotic core
Recurrency of stroke or TIA
The change of percentage in LDL-C from baseline
The change in HDL-C level from baseline
To explore the relationship between the change of plaque volumn and morphology and the change in LDL-C, HDL-C and Hs-CRP level
safety-Rhabdomyolysis,Hepatonecrosis
The change in percentage of thickness of fibrous cap
The change in percentage of intraplaque hemorrhage
The change in hsCRP level from baseline
2.Severe bleeding incidence (GUSTO definition), including fatal bleeding and symptomatic intracranial hemorrhage
Incidence symptomatic and asymptomatic intracranial hemorrhagic events at 3 months
Moderate bleeding (GUSTO definition)
Intracranial hemorrhage
Total mortality
AEs/SAEs reported by the investigators

Full Information

First Posted
January 2, 2014
Last Updated
July 23, 2020
Sponsor
Beijing Tiantan Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT02041117
Brief Title
Resuvastatin Treatment for Symptomatic Middle Cerebral Artery Stenosis Based on High-resolution Magnetic Resonance Imaging
Acronym
REALM
Official Title
Resuvastatin Treatment for Symptomatic Middle Cerebral Artery Stenosis Based on High-resolution Magnetic Resonance Imaging in Two Years
Study Type
Interventional

2. Study Status

Record Verification Date
July 2020
Overall Recruitment Status
Completed
Study Start Date
February 24, 2014 (Actual)
Primary Completion Date
November 6, 2018 (Actual)
Study Completion Date
November 6, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Beijing Tiantan Hospital

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
It is a multicenter, open-label, sing arm study to evaluate the effects of treatment of Rosuvastatin 10-20mg in volume and morphology of atherosclerotic plague by reducing LDL-C level to or less than 70mg/dl. Ischemic stroke patients will be enrolled within 1 month after stroke onset. Patients will be visited at 0m, 1m, 3m, 6m, 9m, 12m, 18m and 24m.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Intracranial Arterial Stenosis

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
162 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Rosuvastatin
Arm Type
Other
Intervention Type
Drug
Intervention Name(s)
Rosuvastatin
Other Intervention Name(s)
Crestor
Intervention Description
Rosuvastatin, 10mg for 4-weeks, then according to the results of the LDL-C, adjust dose of rosuvastatin, maximum to 20 mg/d, to reduce LDL-C under 70 mg/dl for two years.
Primary Outcome Measure Information:
Title
The change in the percentage of volume of MCA atherosclerosis plaque after 2 years treatment of Rosuvastatin 10-20mg
Time Frame
2 year
Secondary Outcome Measure Information:
Title
The change in Percentage of plaque volume of M1segment plaque
Time Frame
6 months and 1 year
Title
The change in Percentage of lumen volume
Time Frame
2 years
Title
The change in percentage of lipid rich necrotic core
Time Frame
2 years
Title
Recurrency of stroke or TIA
Time Frame
2 years
Title
The change of percentage in LDL-C from baseline
Time Frame
2 years
Title
The change in HDL-C level from baseline
Time Frame
2 years
Title
To explore the relationship between the change of plaque volumn and morphology and the change in LDL-C, HDL-C and Hs-CRP level
Time Frame
2 years
Title
safety-Rhabdomyolysis,Hepatonecrosis
Time Frame
2 years
Title
The change in percentage of thickness of fibrous cap
Time Frame
2 years
Title
The change in percentage of intraplaque hemorrhage
Time Frame
2 years
Title
The change in hsCRP level from baseline
Time Frame
2 years
Title
2.Severe bleeding incidence (GUSTO definition), including fatal bleeding and symptomatic intracranial hemorrhage
Time Frame
2 years
Title
Incidence symptomatic and asymptomatic intracranial hemorrhagic events at 3 months
Time Frame
2 years
Title
Moderate bleeding (GUSTO definition)
Time Frame
2 years
Title
Intracranial hemorrhage
Time Frame
2 years
Title
Total mortality
Time Frame
2 years
Title
AEs/SAEs reported by the investigators
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female patients between 18 and 75 years of age. Ischemic stroke originate from middle cerebral artery(MCA) AS stenosis, stroke onset within 1 month. LDL-C level is more than 70mg/dl (1.8mmol/L), but less than 250mg/dl (6.5mmol/L); and triglyceride level is less than 353mg/dl (4.0mmol/L). total term of statin therapy less than 2 month in past 1year before entering the study. (5)30-70% intracranial artery stenosis in M1 segment of MCA comfirmed by CTA or MRI at least 1 or more atherosclerotic plaques in M1 segment of MCA is detectable. (6)Female patients must agree to use an effective form of birth control throughout the 2-year study treatment period. (7)The patients who are willing to be enrolled have to remain on the low cholesterol dietary for the study duration. (8)The patient must be able to comply with scheduled visits, the treatment plan and all laboratory tests. (9)Written informed consent is provided to participate in the study. Exclusion Criteria: Any hemorrhagic stroke or hemorrhagic infarction Presence of any of cardiac sources of embolism Ischemic stroke caused by non MCA stenosis The patients has LDL cholesterol ≤ 70mg/dl or familial hypercholesterolemia. Previous treatment of target lesion with a stent, angioplasty, or other mechanical device, or plan to perform staged angioplasty within 2 years Any aneurysm proximal to or distal to stenotic intracranial artery Intracranial tumor (except meningioma) or any intracranial vascular malformation Thrombolytic therapy within 24 hours before enrollmentnt The patient has plans for surgical/endovascular intervention for intracranial, carotid, coronary and/or peripheral arterial disease during the course of the study. The patient has or is being treated or evaluated for diagnosed tuberculosis. The patient has a history of malignant neoplasm within the previous 5 years (exception: curable non-melanoma skin malignancies). The patient has a known immunodeficient state (e.g., human immunodeficiency virus) or is being treated with immunosuppressive drugs including cyclosporine. The patient has any other clinically significant medical condition that, in the opinion of the Investigator, could impact the patient's ability to successfully complete the trial. Life expectancy of patients is less than 2 years. The patient have to take medicines as follow: Hormonal therapy, Cyclosporine and other lipid lowering agents: fish oil, garlic essential oil etc. The patient has a history of recent alcohol abuse, drug abuse or significant mental illness. The patient has any condition that would prevent the patient from giving voluntary informed consent. The patient has an inability to tolerate oral medication administration. The patient has a known or suspected allergy to the study medication(s) or the class of study medication to be administered. The patients cannot finish HR-MRI for any reasons. Pregnancy or of childbearing potential and unwilling to use contraception for the duration of this study The patient is enrolled or plans to enroll in another clinical drug or device/interventional trial during this study. The patient has the history of epilepsy/seizures. The patient has liver function tests > 1.5 times the upper limit of normal, serum creatinine > 2.0 mg/dL, GFR < 30 ml/min or has abnormal laboratory values which are deemed clinically significant by the investigator. The patient has the history of myopathy. The patient has thyroid stimulating hormone > 1.5xULN. BMI ≥ 30 kg/m2
Facility Information:
Facility Name
Beijing Tiantan Hospital affliated to Capital Medical University
City
Beijing
State/Province
Beijing
Country
China

12. IPD Sharing Statement

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Resuvastatin Treatment for Symptomatic Middle Cerebral Artery Stenosis Based on High-resolution Magnetic Resonance Imaging

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