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Stroke, AcuteEASINCT02157532

Endovascular Acute Stroke Intervention Trial - the EASI Trial

A study testing mechanical thrombectomy and Best standard treatment in people with Stroke, Acute, run by Centre hospitalier de l'Université de Montréal (CHUM) at 2 sites in Canada.

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Official record
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Trial summary

Stroke constitutes the primary cause of acquired disability in adults and the second cause of dementia following Alzheimer disease. It has been shown that patients with a moderate to severe clinical score have occlusion of brain large vessels, resulting in a worse clinical outcome. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Stroke, Acute
What is being tested?
mechanical thrombectomy and Best standard treatment
Could I receive a placebo?
No, everyone receives an active treatment
How many people
480 participants
Where
2 sitesCanada
Study dates
Jan 2013to Jan 2026
Phase
Interventional
Are there results?
None posted in the registry

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 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age greater than or equal to 18
  • NIHSS greater than or equal to 8
  • onset of symptoms is less than 5 hours OR symptom/imaging mismatch
  • suspected occlusion of the M1 or M2 segment of the MCA, supraclinoid ICA, or basilar trunk.

Who cannot join

  • established infarction of the target symptomatic territory
  • co-morbid diseases which suggest a poor 90 day outcome irrespective of management
  • radiologic evidence of hemorrhagic transformation of the infarcted territory

Trial locations and contacts

2 sites in 1 country.

Canada2 sites
  • University of Alberta Hospital

    Edmonton, Alberta

  • Centre Hospitalier de l'Université de Montréal - Hôpital Notre Dame

    Montreal, Quebec, H2L 4M1

Other trials in Canada

About this study

Official title: Intra-arterial Thrombectomy as an Acute Treatment Intervention for Stoke: the Endovascular Acute Stoke Intervention (EASI) Trial

Stroke constitutes the primary cause of acquired disability in adults and the second cause of dementia following Alzheimer disease. It has been shown that patients with a moderate to severe clinical score have occlusion of brain large vessels, resulting in a worse clinical outcome. Many studies have demonstrated that early recanalization after IV rtPA is more restricted, the larger and more proximal the artery. Several systems for mechanical intracranial arterial thrombectomy of large trunks have recently been proposed and are now available. Potential advantages of these mechanical systems on chemical thrombolysis are speed (a few minutes versus 1 hour) and absence of thrombolytic injection.

The objective of the EASI trial is thus to:

Read more
  • To validate intra-arterial thrombectomy use during the acute phase of cerebral stroke in patients treated with IV thrombolysis or in patients for whom thrombolysis is contra-indicated.
  • To determine whether a combined approach, standard treatment plus thrombectomy, is superior to standard treatment alone within 5 h of the appearance of symptoms, in patients with occlusion of proximal cerebral arteries following moderate to severe stroke (NIHSS larger than or equal to 8), evaluated at 3 months.

The design is a randomized, controlled multicentric trial, with a parallel comparison between standard and combined (standard plus thrombectomy) treatment.

480 patients fulfilling eligibility criteria will be sufficient to demonstrate the primary hypothesis of a 15% difference in number of subjects with a favorable mRS (less than or equal to 2) at 3 months, with the assumption of a 25% efficacy for IV thrombolytic treatment at 3 months.

IV thrombolysis is carried out according to standard practice. Mechanical thrombectomy is carried out with already approved devices, according to the manufacturer's instructions, following a diagnostic cerebral angiography.

The primary efficacy endpoint is clinical: favorable mRS (less than or equal to 2) at 3 months.

The primary safety endpoint is rate of death at 3 months and rate of symptomatic hemorrhage at 24 hours.

If the primary hypothesis is validated, expected benefits of this study is a higher rate of autonomy for stroke patients with all the attendant consequences: reduction in hospital stays, and a faster return to the activities of daily life.

Read the detailed description

Background Stroke constitutes the primary cause of acquired disability in adults and the second cause of dementia following Alzheimer disease. The burden of disease may be substantial since 25% of the victims of stroke are younger than 65 years. Standard treatment is IV rtPA thrombolysis, within 3-4.5 hours of first signs. It has been shown that patients with a moderate to severe clinical score (NIHSS more than 10) have occlusion of proximal large vessels, resulting in a more adverse clinical outcome. Many studies have demonstrated that early recanalization after IV rtPA is more restricted, the larger and more proximal the artery. Recanalization of large arteries occurs more frequently and earlier (leading to better prognosis) with arterial than with venous access. Biochemical arterial treatment appears thus of greater efficacy in terms of recanalization of large vessels, but more inconvenient with respect to setup delays. Several systems for mechanical intracranial arterial thrombectomy of large trunks have recently been proposed and are now available. Results of short case series and prospective multicentric non randomized studies appear favorable. The thrombus obstructing the artery is reached by endovascular means and mechanically removed with the result that orthograde blood flow is re-established in the cerebral territory involved in the ischemia. Potential advantages of these mechanical systems on chemical thrombolysis are speed (a few minutes versus 1 hour) and absence of thrombolytic injection. Mechanical thrombolysis should thus lead to better results than injection of an arterial thrombolytic agent, as well as increase the time window for treatment. In addition, hemorrhagic complications should be reduced.

Objectives

In situations where IV rtPA thrombolysis is not optimal, that is in presumed embolic occlusions of large intracranial arterial trunks (terminal carotid, initial segment of the MCA, distal third of the basilar trunk) with a moderate to severe clinical state (NIHSS greater or equal to 8) and in situations when IV rtPA may be contra-indicated:

  • To validate intra-arterial thrombectomy use during the acute phase of cerebral stroke in patients treated with IV thrombolysis or in patients for whom thrombolysis is contra-indicated.
  • To determine whether a combined approach, standard treatment plus thrombectomy, is superior to standard treatment alone within 5 h of the appearance of symptoms, in patients with occlusion of proximal cerebral arteries following moderate to severe stroke (greater or equal to 8), evaluated at 3 months.

Design EASI is a randomized, controlled multicentric trial, with a parallel comparison between standard and combined (standard plus thrombectomy) treatment. All adults presenting less than 5 hours after the beginning of symptoms with an NIHSS greater or equal to 8 discordant with imaging data are eligible. Occlusion site, when available, includes intracranial carotid artery, M1 segment of middle cerebral and basilar artery.

480 patients fulfilling eligibility criteria will be sufficient to demonstrate the primary hypothesis of a 15% difference in number of subjects with a favorable mRS (greater than 2) at 3 months, with the assumption of a 25% efficacy (mRS less or equal to 2) for IV thrombolytic treatment at 3 months.

Randomization may take place any time following admission, including during IV thrombolysis. The choice of early randomization, without knowledge of the clinical or angiographic results of IV thrombolysis fulfils several objectives: allow timely delivery of a proven treatment; prevent unnecessary exposure to angiography risks; set up thrombectomy as fast as possible for a maximal efficacy.

IV thrombolysis is carried out according to standard practice. Mechanical thrombectomy is carried out with already approved devices, according to the manufacturer's instructions, following a diagnostic cerebral angiography.

Follow-up includes brain imaging and the mRS at 3 months.

Endpoint measures include:

  • Clinical endpoints as measured by the neurologist, and include the NIHSS at baseline and the mRS at 3 months.
  • Safety data: complications, death at 3 months, hemorrhage according to 24 hours CT scan.

The primary efficacy endpoint is clinical: favorable mRS (less than or equal to 2) at 3 months.

The primary safety endpoint is rate of death at 3 months and rate of symptomatic hemorrhage at 24 hours.

Secondary efficacy endpoints include:

  • Comparison of ASPECTS score between baseline and 24 hours CT scans
  • In thrombectomy group, blood flow in treated territory as measured by a TICI reperfusion score of 2 or 3 at end of treatment.

Secondary safety endpoints include

  • Rate of hemorrhage on 24 hours CT scan
  • Frequency and severity of complications of standard treatment
  • Frequency and severity of arterial complications in thrombectomy group
  • Frequency and severity of complications at puncture site in thrombectomy group
Conditions
Stroke, Acute
Being tested
mechanical thrombectomy, Best standard treatment
Keywords
Severe stroke, IV tPA, mechanical thrombectomy
Medical subject headings
Stroke

What participants receive

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

  • mechanical thrombectomyProcedure or surgery

    Mechanical thrombectomy using any already approved stent-retriever device

  • Best standard treatmentDrug

    Also called Medical management

    Intravenous r-tPA infusion or any other medical management option

Study groups in NCT02157532
Study groupRoleWhat they receive
Best standard treatmentActive comparatorintravenous r-tPA or any other medical management
Receives: Drug: Best standard treatment
Mechanical thrombectomyActive comparatorEndovascular mechanical thrombectomy with stent-retrievers
Receives: Procedure: mechanical thrombectomy

What is being measured

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

  1. clinical (efficacy): favorable modified Rankin Score (less than or equal to 2)

    The efficacy of mechanical thrombectomy compared to standard stroke treatment will be evaluated using the modified Rankin scale score at 3 months. This measure includes the rate of death within 3 months

    Measured: 3 months

  2. Rate of symptomatic intracranial hemorrhage

    the incidence of symptomatic hemorrhage on non-contrast CT at 24 hours will be recorded

    Measured: 24 hours

Secondary outcomes (4)
  1. Infarct evolution

    the evolution of the infarct on CT will be carried out according to a semi-quantitative evaluation using the ASPECT score between the pre-treatment CT and the 24 hour cross-sectional imaging study

    Measured: 24 hours

  2. Angiographic outcome in patients allocated to mechanical thrombectomy

    In patients allocated to the mechanical thrombectomy arm, the occlusion state of the target vessel will be assessed at the end of the intervention according to the TICI scale

    Measured: 2 hours

  3. Frequency and Severity of complications

    All Adverse Events

    Measured: 3 months

  4. Rate of intracranial hemorrhage

    The incidence of hemorrhage on non-contrast CT at 24 hours will be recorded

    Measured: 24 hours

Timeline

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

  1. First posted6 Jun 2014 (estimated)
  2. Study startJan 2013
  3. Primary completionJan 2025 (estimated)
  4. Study completionJan 2026 (estimated)

Why it stopped: Sites are not recruiting.

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 N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
480 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02157532
Sponsor's protocol ID
CE 12.224
Acronym
EASI
Status last verified
Sep 2024
First submitted
2 Jun 2014
Last updated
19 Sep 2024
Results posted
No
Data monitoring committee
Yes

Publications

  • Poppe AY, Jacquin G, Stapf C, Daneault N, Deschaintre Y, Gioia LC, Odier C, Labrie M, Nehme A, Nico L, Roy D, Weill A, Raymond J. A randomized pilot study of patients with tandem carotid lesions undergoing thrombectomy. J Neuroradiol. 2020 Nov;47(6):416-420. doi: 10.1016/j.neurad.2019.08.003. Epub 2019 Sep 26.

    PubMed 31563589
  • Khoury NN, Darsaut TE, Ghostine J, Deschaintre Y, Daneault N, Durocher A, Lanthier S, Poppe AY, Odier C, Lebrun LH, Guilbert F, Gentric JC, Batista A, Weill A, Roy D, Bracard S, Raymond J; EASI trial collaborators. Endovascular thrombectomy and medical therapy versus medical therapy alone in acute stroke: A randomized care trial. J Neuroradiol. 2017 Jun;44(3):198-202. doi: 10.1016/j.neurad.2017.01.126. Epub 2017 Feb 24.

    PubMed 28238522

Questions about this trial

What is this clinical trial studying?

A study testing mechanical thrombectomy and Best standard treatment in people with Stroke, Acute, run by Centre hospitalier de l'Université de Montréal (CHUM) at 2 sites in Canada.

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 4 inclusion and 3 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: paused, as of the sponsor's last update on 19 Sep 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in 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.

Are results available for this study?

Results are not available in the source record.

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?

clinical (efficacy): favorable modified Rankin Score (less than or equal to 2) (time frame: 3 months). The study lists 2 primary outcomes in all. 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 NCT02157532, 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 19 Sep 2024; AzTrials last refreshed its copy on 31 Oct 2026.

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