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StrokePhase 2MR RESCUENCT00389467

Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy

A Phase 2 study testing Merci Retriever and Penumbra System in people with Stroke, run by University of California, Los Angeles at 22 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to compare the effectiveness of treating acute ischemic stroke with mechanical embolectomy using the Merci Retriever or the Penumbra System within 8 hours of symptom onset to standard medical treatment, and to identify people who might benefit from mechanical embolectomy by the appearance… Read more about this study

Who is it for?
Ages 18 to 85 years
Conditions the study is for
Stroke
What is being tested?
Merci Retriever and Penumbra System
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
127 participants
Where
22 sitesin 2 countries
Study dates
May 2004to Apr 2012
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • New focal disabling neurologic deficit consistent with acute cerebral ischemia (NIHSS >/= 6)
  • Age >/= 18 ≤ 85
  • Clot retrieval procedure can be initiated within 8 hours from onset
  • Large vessel proximal anterior circulation occlusion on MR or CT angiography (internal carotid, M1 or M2 MCA)
  • Pretreatment MRI performed according to MR RESCUE protocol
  • Signed informed consent obtained from the patient or patient's legally authorized representative
  • Premorbid modified Rankin score of 0-2
  • Allowed but not required: patients treated with IV tPA (tissue plasminogen activator) up to 4.5 hours from symptom onset with persistent target occlusion on post-treatment MR RESCUE MR or CT protocol performed at the completion of drug infusion (Note: Rapidly improving neurological signs prior to randomization is an exclusion)

Who cannot join

  • NIHSS >/= 30
  • Contraindication to MRI (pacemaker etc)
  • Acute intracranial hemorrhage
  • Coma
  • Rapidly improving neurological signs prior to randomization
  • Pre-existing medical, neurological or psychiatric disease that would confound the neurological, functional, or imaging evaluations
Show all 27Show fewer
  • Pregnancy
  • Known allergy to iodine previously refractory to pretreatment medications
  • Current participation in another experimental treatment protocol
  • Contrast-Enhanced Neck MRA (magnetic resonance angiography) or CTA (computed tomography angiography) suggests proximal ICA occlusion, proximal carotid stenosis > 67%, or dissection
  • INR > 3.0 (international normalized ratio)
  • PTT > 3 x Normal (partial thromboplastin time)
  • Imaging data cannot be processed by the MR RESCUE computer
  • Renal Failure (serum creatinine > 2.0 or Glomerular Filtration Rate [GFR] < 30)
  • MRI Exclusion Criteria:
  • Contraindication to MRI (pacemaker, etc)
  • CT Exclusion Criteria:
  • Contraindication to iodinated contrast**
  • Examples of possible iodinated contrast contraindications include:
  • Hyperthyroidism
  • History of severe allergic reaction to iodinated contrast material
  • History of sever kidney disease as an adult, including tumor or transplant surgery, or family history of kidney failure
  • Paraproteinemia syndromes or multiple myeloma
  • Collagen vascular disease
  • Severe cardiac insufficiency
  • Severely compromised liver function
  • Current therapy with metformin, aminoglycosides

Trial locations and contacts

22 sites in 2 countries.

22 sites in 2 countries

United States21 sites
  • Suburban Hospital, 8600 Old Georgetown Road, Bethesda, MD 20814

    Bethesda, Maryland, 20814

  • Boston University, One Boston Medical Center Place, Department of Neurology, C329

    Boston, Massachusetts, 01228

  • Massachusetts General Hospital, 101 Huntington Ave Ste 300

    Boston, Massachusetts, 02199

  • Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29403

    Charleston, South Carolina, 29403

  • Chattanooga Center for Neurologic Research

    Chattanooga, Tennessee

  • University of Cincinnati, Department of Neurology, University of Cincinnati Medical Center, 231 Albert Sabin Way, Medical Sciences Bldg, Rm 4015, PO Box 670525

    Cincinnati, Ohio, 45267

  • University of Texas at Houston, University of Texas, Houston Stroke Program, Department of Neurology, 6431 Fannin Street, MSB 7044

    Houston, Texas, 77030

  • University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242

    Iowa City, Iowa, 52242

  • University of California at Los Angeles, UCLA Stroke Network, 924 Westwood Blvd #300

    Los Angeles, California, 90024

  • Kaiser Permanente Los Angeles Medical Center 4867 W Sunset Blvd., Los Angeles CA 90027

    Los Angeles, California, 90027

  • Cedars Sinai Medical Center 8700 Beverly Blvd., Los Angeles CA 90048

    Los Angeles, California, 90048

  • University of Miami 1400 NW 10th Street, 10th Floor, Miami FL 33136

    Miami, Florida, 33136

  • West Virginia University 1 Medical Center, Morgantown WV 26506

    Morgantown, West Virginia, 26506

  • Cornell University, New York Presbyterian Hospital, Cornell Campus, 525 East 68th St, Box 141

    New York, New York, 10021

  • Columbia University, 710 W 168th St, NI 551, ,

    New York, New York, 10032

  • University of Pittsburgh, PUHC-426, 200 Lothrop Street

    Pittsburgh, Pennsylvania, 15213

  • University of California at San Diego, UCSD Medical Center, 200 W. Arbor Drive, OPC, 3rd Floor Suite 3

    San Diego, California, 92103

  • Santa Monica-UCLA Medical Center, 1225 15th Street Santa Monica, CA 90404

    Santa Monica, California, 90404

  • St. Louis University Hospital, 3635 Vista Avenue at Grand Boulevard Saint Louis, MO

    St Louis, Missouri, 63110

  • Georgetown University, Georgetown University Hospital, Room GG012, Ground Floor Gorman, 3800 Reservoir Road, NW

    Washington D.C., District of Columbia, 20007

  • Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010

    Washington D.C., District of Columbia, 20010

Other trials in United States

Canada1 site
  • University of Calgary

    Calgary, Alberta

Other trials in Canada

About this study

The purpose of this study is to compare the effectiveness of treating acute ischemic stroke with mechanical embolectomy using the Merci Retriever or the Penumbra System within 8 hours of symptom onset to standard medical treatment, and to identify people who might benefit from mechanical embolectomy by the appearance of stroke on multimodal computerized tomography (CT) or magnetic resonance (MR) imaging.

Read the detailed description

Stroke most commonly occurs when there is a blockage of blood flow to one of the arteries in the brain. The blockage is often caused by a clot. There is currently only one FDA-approved stroke treatment. However, only 2 percent of ischemic stroke patients receive this treatment because it must be given within 4.5 hours of the stroke onset. There is an overwhelming need for new treatments that extend the time window to treatment since most individuals with stroke arrive at the hospital after the 4.5-hour time window.

Two of the most promising new devices are the Merci Retriever, a tiny corkscrew device, and the Penumbra System, an aspiration device. Both are designed to remove clots from arteries and thereby restore blood flow to the brain.

The primary purpose of this study is to compare the effectiveness of treatment with the Merci Retriever or Penumbra System within 8 hours of symptom onset to standard medical treatment, and to identify people who might benefit from the devices by the appearance of the stroke on multimodal computerized tomography (CT) or magnetic resonance imaging (MRI). Previous testing has determined that the use of the Merci Retriever is successful in opening up blocked blood vessels in approximately ½ of the individuals in whom it is used, and the Penumbra System is successful in opening up blocked blood vessels in approximately 80% of the individuals in whom it is used.

A total of 120 participants from approximately 30 different medical centers will be enrolled into this study. Participants will be randomized to either receive treatment by mechanical embolectomy with the Merci Retriever or Penumbra System and standard medical care or treatment with standard medical care alone. Standard care for stroke patients may include intravenous fluid, careful regulation of blood pressure, blood-thinning medicine (such as heparin or warfarin), anti-platelet medicine (such as aspirin or clopidogrel), and rehabilitation therapies.

Participants undergoing the Merci Retriever or Penumbra System procedure will have a cerebral arteriogram with pictures taken with dye prior to the procedure to determine the location of the blockage, and following the procedure to determine if blood supply has been restored. The total mechanical embolectomy procedure with either device will take approximately 1 to 2 hours. Participants will have brief neurological exams several times during this time to monitor changes in their neurological condition.

Participants will have follow-up visits, including neurological exams, at 30 days and at 90 days.

This study is part of the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS), which allows researchers to enhance and initiate translational research that ultimately will benefit stroke patients by treating more patients in less than 2 hours, and finding ways to treat additional patients later.

Conditions
Stroke
Being tested
Merci Retriever and Penumbra System
Keywords
stroke, ischemic stroke, blood clot, Merci Retriever, Penumbra System, embolectomy, magnetic resonance imaging, MRI, CT, SPOTRIAS
Medical subject headings
Stroke, Ischemic Stroke, Thrombosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Merci Retriever and Penumbra SystemDevice

    The MERCI (Mechanical Embolus Removal in Cerebral Ischemia) Retriever consists of a flexible, nickel titanium (nitinol) wire with a helical-shaped distal tip. The helical distal tip is covered with a platinum radiopaque coil, which facilitates fluoroscopic visualization. The body of the MERCI Retriever is covered with a hydrophilic coating that helps facilitate device placement. The MERCI Retriever is available in 6 configurations (Merci Retrievers X6, L5, L4, L6, V series, DAC).

    The Penumbra System uses a reperfusion catheter in parallel with a separator component and an aspiration source to achieve separation of the thrombus and subsequent aspiration of the occlusion from the vessel. The system is available in different sizes according to the target vessels (041 Reperfusion Catheter/Separator pair for use in vessels larger than 3mm, notably the ICA and M1; 032 Reperfusion Catheter/Separator pair for use in vessels 2mm - 3mm, notably the M2).

Study groups in NCT00389467
Study groupRoleWhat they receive
1 Mechanical EmbolectomyActive comparatorParticipants will be randomized to receive mechanical embolectomy treatment either with the Merci Retriever or Penumbra System and standard medical care or treatment with standard medical care alone.
Receives: Device: Merci Retriever and Penumbra System
2No interventionstandard medical care

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The Modified Rankin Scale Score

    Scale name is provided (Modified Rankin Scale) which is a standard measure of functional neurologic outcome in stroke. The scale runs from 0-6, running from perfect health without symptoms to death.

    • 0 - No symptoms.
    • 1 - No significant disability. Able to carry out all usual activities, despite some symptoms.
    • 2 - Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities.
    • 3 - Moderate disability. Requires some help, but able to walk unassisted.
    • 4 - Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted.
    • 5 - Severe disability. Requires constant nursing care and attention, bedridden, incontinent.
    • 6 - Dead.

    Measured: at 90 days post-stroke

Secondary outcomes (2)
  1. Symptomatic Hemorrhagic Transformation

    Symptomatic intracranial hemorrhage is defined as 4 point neurologic worsening on the National Institutes of Health Stroke Scale (NIHSS) score associated with parenchymal hematoma type 2 (PH-2*), remote intracerebral hemorrhage, subarachnoid hemorrhage, or intraventricular hemorrhage on imaging. The NIHSS is a scale measuring specific neurologic deficits caused by a stroke with scores ranging from 0 to 42, and higher scores indicating more severe neurologic deficits.

    *from the modified European Cooperative Acute Stroke Study (ECASS) II criteria

    Measured: from baseline to day 7

  2. Day 90 Mortality

    Measured: at day 90

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Oct 2006 (estimated)
  2. Study startMay 2004
  3. Primary completionApr 2012
  4. Study completionApr 2012

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
127 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00389467
Sponsor's protocol ID
P50NS044378
Other IDs
NCT00389467
Acronym
MR RESCUE
Status last verified
Feb 2014
First submitted
16 Oct 2006
Last updated
26 Mar 2014
Data monitoring committee
Yes

Publications

  • Nael K, Knitter JR, Jahan R, Gornbein J, Ajani Z, Feng L, Meyer BC, Schwamm LH, Yoo AJ, Marshall RS, Meyers PM, Yavagal DR, Wintermark M, Liebeskind DS, Guzy J, Starkman S, Saver JL, Kidwell CS. Multiparametric Magnetic Resonance Imaging for Prediction of Parenchymal Hemorrhage in Acute Ischemic Stroke After Reperfusion Therapy. Stroke. 2017 Mar;48(3):664-670. doi: 10.1161/STROKEAHA.116.014343. Epub 2017 Jan 30.

    PubMed 28138001
  • Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z, Feng L, Meyer BC, Olson S, Schwamm LH, Yoo AJ, Marshall RS, Meyers PM, Yavagal DR, Wintermark M, Guzy J, Starkman S, Saver JL; MR RESCUE Investigators. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med. 2013 Mar 7;368(10):914-23. doi: 10.1056/NEJMoa1212793. Epub 2013 Feb 8.

    PubMed 23394476

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Merci Retriever and Penumbra System in people with Stroke, run by University of California, Los Angeles at 22 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 27 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 26 Mar 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 22 sites in United States, Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 26 Mar 2014). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The Modified Rankin Scale Score (time frame: at 90 days post-stroke). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00389467, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 Mar 2014.

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