AzTrials
AzTrials

Idiopathic Intracranial HypertensionNCT03556085

Venous Sinus Stenting With the River Stent in IIH

A study testing Venous sinus stenting (Serenity River) in people with Idiopathic Intracranial Hypertension, run by Serenity Medical, Inc. at 6 sites in United States.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
Search all trials

Trial summary

The objective of the study is to show that stenting the transverse-sigmoid sinus with the River stent is safe and has probable benefit to relieve clinical symptoms in subjects with idiopathic intracranial hypertension (IIH). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Idiopathic Intracranial Hypertension
What is being tested?
Venous sinus stenting (Serenity River)
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
39 participants
Where
6 sitesUnited States
Study dates
24 Aug 2018to 1 Nov 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

  • Subjects must meet all of the following criteria to be eligible for participation in the study:
  • Subject is > 18 year-old and has given informed consent.
  • Diagnosis of IIH per Modified Dandy Criteria.
  • CSF opening pressure is > 25 cm H2O.
  • Radiological examination (magnetic resonance venography (MRV) or computed tomographic venography (CTV)) shows bilateral transverse-sigmoid venous sinus stenosis (> 50%) or unilateral stenosis of the dominant sinus with contralateral hypoplastic sinus.
  • Presence of IIH clinical symptoms (6. OR 7.)
Show all 11Show fewer
  • Headaches: Score > 59 (severe impact) on the HIT-6 scale, refractory to medical therapy (e.g. acetazolamide 1000 mg twice daily, topiramate 100 mg twice daily, or other headache medication) for ≥ 4 weeks, or treatment intolerance OR
  • Visual field loss: defined by perimetric mean deviation (PMD) between -6 dB and -30 dB in one or both eyes (with papilledema Grade >1) despite at least 2 weeks of medical therapy with acetazolamide 1000 mg twice daily, or if the visual field deteriorates by more than 2 dB during treatment, or treatment intolerance.
  • In the absence of this study, the subject would have been offered a surgical intervention by Optic Nerve Sheath Fenestration (ONSF), Cerebro Spinal Fluid (CSF) shunting procedure, or venous sinus stenting with an off-label device.
  • Catheter manometry shows a pressure gradient > 8 mm Hg across the transverse sigmoid sinus stenosis.
  • Venographic evidence of sinus stenosis (> 50%)

Who cannot join

  • Subject must be excluded from participation in this study if any of the following criteria are met
  • Subjects presenting with de novo papilledema and severe visual field(VF) deficit (VF loss > -15db) that requires immediate surgical treatment without prior attempt of medical therapy.
  • Currently has or plans to have an implanted CSF shunt.
  • History of previously implanted intra-cranial sinus stent.
  • Transverse-sigmoid sinus vessel size <5 mm or >10 mm.
  • Creatinine > 1.5 mg/dl and/or creatinine clearance < 60 mL/min (except if patients is already on hemodialysis).
Show all 27Show fewer
  • Allergic to imaging contrast media (iodine or gadolinium) despite premedication.
  • Allergic to nitinol or nickel.
  • Contra-indication to general anesthesia.
  • Contra-indication to aspirin, clopidogrel or other anticoagulant.
  • Hypercoagulable state (Factor V Leiden, Protein C or S deficiency, Anticardiolipin antibodies, Lupus anticoagulant, B2-glycoprotein-1 antibodies, or Hyperhomocysteinemia).
  • Currently requiring full anti-coagulation for other medical reasons, such as atrial fibrillation (AF), artificial valves, deep vein thrombosis pulmonary embolism, etc.
  • History of stroke or transient ischemic attack (TIA).
  • History of AF or other risks of stroke.
  • History of deep vein thrombosis or pulmonary embolism.
  • History of severe chronic obstructive pulmonary disease or other severe respiratory disease.
  • History of severe carotid atherosclerotic disease.
  • History of heart failure, dilated cardiomyopathy, or congenital heart conditions, etc. that are at high thrombogenic risk.
  • History of uncontrolled diabetes.
  • Use (oral) of tetracycline derivative, retinoid or vitamin A during the last 3 months.
  • Cerebral vascular lesions (arteriovenous malformation (AVM), arteriovenous fistula, aneurysms, significant stenosis of extra- or intra-cranial vessels other than the targeted venous sinus stenosis,intracranial artery dissection, etc.).
  • Patient has visions loss due to other disease (e.g. cataract, macular degeneration, glaucoma, etc.).
  • Inability to provide reliable and reproducible visual field examinations (>15% false positive errors and/or failure to maintain fixation for eye monitoring).
  • For female subject of child bearing potential, pregnant or not willing to use contraception for 12 months.
  • Presence of a physical, mental or social condition that could prevent adequate one-year follow-up (homelessness, drug dependency, anticipation of moving far away, life threatening disease, terminal illness).
  • Anatomical anomaly of the venous sinus which would prevent safe catheterization and stenting (e.g multi-channel sinus)
  • Currently enrolled in a premarket investigational study. Enrollment in a post market study that does not impact the River™ Stent procedure or device is allowed.

Trial locations and contacts

6 sites in 1 country.

6 sites in 1 country

United States6 sites
  • UB Neurosurgery

    Buffalo, New York, 14203

  • Baptist Health

    Jacksonville, Florida, 32207

  • Northwell Health

    Manhasset, New York, 11030

  • Weill Cornell Medicine

    New York, New York, 10065

  • Oregon Health & Science University

    Portland, Oregon, 97239

  • Wake Forest University Health Sciences

    Winston-Salem, North Carolina, 27157

Other trials in United States

About this study

Official title: Clinical Evaluation of the Serenity River Stent System to Treat Idiopathic Intracranial Hypertension

The objective of the study is to show that stenting the transverse-sigmoid sinus with the River stent is safe and has probable benefit to relieve clinical symptoms in subjects with idiopathic intracranial hypertension (IIH).

The study will enroll 39 IIH subjects with moderate to severe visual field loss or severe headaches that have failed medical therapy.

The primary safety endpoint is the rate of major adverse event at 12 months The primary probable benefit endpoint is a composite at 12 months of absence of significant sinus stenosis and clinically relevant improvement.

Read the detailed description

Study objective: The objective of the study is to show that stenting the transverse-sigmoid sinus with the River stent is safe and has probable benefit to relieve clinical symptoms in subjects with idiopathic intracranial hypertension (IIH)

Investigational product: Serenity River Stent System

Study design: prospective, multicenter, single arm, open label clinical trial

Subject population: IIH subjects with significant (>50%) stenosis of the transverse-sigmoid sinuses and moderate to severe visual field loss or severe headaches that have failed medical therapy. In the absence of this trial, subjects would have been offered a surgical treatment of IIH such as sinus stenting with an off-label device, cerebrospinal fluid shunting, or optic nerve sheath fenestration by the treating physician.

  • For subjects with visual field loss: if moderate to severe visual field loss (mean deviation between -6db and -30 db) for at least 2 weeks despite escalation of acetazolamide to 1000 mg twice a day or if the visual field deteriorates by more than 2 db during treatment, or treatment intolerance.
  • For subjects with headaches: if they have severe headaches (HIT > 59) for at least 4 weeks despite treatment with topiramate 100 mg twice a day or other headache medication, or treatment intolerance.

Enrollment size and sites: 39 subjects will be enrolled in up to 10 US sites.

Primary safety endpoint: Major Adverse Event at 12 months. The MAE is a composite of the following: moderate or severe stroke (NIHSS > 3), neurological death, perforation or thrombosis of sinus or cerebral vein, device distal embolization, need for target lesion revascularization or need for alternate IIH surgical procedure such as cerebrospinal fluid shunting or optic nerve sheath fenestration.

Primary probable benefit endpoint: a composite at 12 months of:

  • Absence of significant (>50%) stenosis of the stented sinus on retrograde catheter venography and
  • Trans-stent pressure gradient < 8 mm Hg and
  • Clinically relevant improvement in the main clinical outcome per specific inclusion criteria and stabilization or better of the other:
  • Headaches: if the specific inclusion criteria was headaches, improvement in the HIT- 6 scale by > 4 points and improvement or stabilization of visual field.
  • Ophthalmic: if the specific inclusion criteria was visual field loss, improvement of visual field by > 29% of the baseline value in the study eye, stabilization or improvement in the fellow eye, and improvement or stabilization of headaches.

Study duration and follow-up: The subjects will be followed at 2 weeks, 3 months, 6 months and 12 months. At 12 months, clinical examination, lumbar puncture and retrograde catheter venography with manometry will be performed to evaluate the patency of the treated sinus and the absence of trans-stent pressure gradient. Subjects will be consented to be clinically followed annually for up to 5 years.

Being tested
Venous sinus stenting (Serenity River)
Keywords
idiopathic intracranial hypertension, venous sinus stenting
Medical subject headings
Pseudotumor Cerebri

What participants receive

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

  • Venous sinus stenting (Serenity River)Device

    Patient is placed under general anesthesia. From femoral vein access, a standard guide-catheter is advanced in the internal jugular vein (on the side considered for stenting). The sigmoid then transverse sinus is catheterized with a microcatheter and guide-wire and an exchange guide-wire is placed in the superior sagittal sinus. The River stent delivery catheter is advanced over the exchange guide-wire in the sigmoid then transverse sinus up to the torcula. The River stent is deployed to cover the entire transverse sinus and the proximal half of the sigmoid sinus. The catheters are removed and hemostasis obtained by using a closure device or manual compression. The patient is kept overnight in the hospital for observation.

Study groups in NCT03556085
Study groupRoleWhat they receive
Venous sinus stentingExperimentalSubjects will have stenting of the transverse-sigmoid sinus
Receives: Device: Venous sinus stenting (Serenity River)

What is being measured

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

  1. Major Adverse Event (MAE)

    The MAE is a composite of the following:

    Moderate or severe stroke (NIH stroke scale > 3) Neurological death Perforation of sinus or cerebral vein Thrombosis of sinus or cerebral vein Device distal embolization Need for target lesion revascularization or need for IIH alternate procedure (cerebrospinal fluid shunting or optic nerve sheath fenestration)

    Measured: 12 months

  2. Clinical improvement with no restenosis of the venous sinus

    The primary probable benefit endpoint is a composite of:

    1. Absence of significant stenosis (defined as >50% stenosis of reference vessel diameter) of the main dural venous sinus on retrograde catheter venography (RCV) AND
    2. Trans-stent pressure gradient (measured during the RCV) < 8 mm Hg AND
    3. Clinically relevant improvement in the main clinical outcome per specific inclusion criteria (headache or ophthalmic) and stabilization or better of the other

    Measured: 12 months

Secondary outcomes (11)
  1. Individual components of MAE.

    Components of MAE will be reported as individual event rates.

    Measured: 12 months

  2. Cerebrospinal fluid (CSF) opening pressure at 12 months

    CSF opening pressure will be measured via lumbar puncture in the lateral decubitus position.

    Measured: 12 months

  3. Stent patency at 12 months

    Stent patency will be assessed by retrograde catheter venography. Patency is defined as absence of significant (>50%) stenosis

    Measured: 12 months

  4. Medications

    Change in IIH medications and dosage at 12 months compared to baseline

    Measured: 12 months

  5. Headaches

    Change in headaches assessed using the Headache Impact Test (HIT-6) scale (minimum score 36, maximum 78; higher value represents worse headache) at 12 months compared to baseline.

    Measured: 12 months

  6. Papilledema

    Change in papilledema grading using Frisen scale (Stage 0 to 5; stage 0 represents no papilledema and is the best outcome) at 12 months compared to baseline.

    Measured: 12 months

  7. Visual acuity

    Change in visual acuity using the Early treatment Diabetic Retinopathy (ETDRS) chart at 12 months compared to baseline.

    Measured: 12 months

  8. Retinal Nerve Fiber Layer Thickness

    Change in retinal nerve fiber layer thickness measured using Optical Coherence Tomography (OCT) at 12 months compared to baseline.

    Measured: 12 months

  9. Tinnitus

    Change in the intensity of tinnitus evaluated on the Tinnitus Functional Index (TFI) score (overall score; minimum 0, maximum 100; 100 is the worst tinnitus with the worst negative impact) at 12 months compared to baseline.

    Measured: 12 months

  10. Quality of Life SF-12

    Change in quality of life assessed with the Short Form health survey 12 items (SF-12) at 12 months compared to baseline

    Measured: 12 months

  11. Quality of Life NEI-VFQ-25

    Change in quality of life assessed with the National Eye Institute - Visual Functioning Questionnaire - 25 at 12 months compared to baseline.

    Measured: 12 months

Timeline

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

  1. First posted14 Jun 2018
  2. Study start24 Aug 2018
  3. Primary completion1 Oct 2022
  4. Study completion1 Nov 2026 (estimated)

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
Not applicable
Intervention model
Single group
Model description
Prospective, multicenter, single arm, open label clinical study
Masking
None (open label)
Enrolment
39 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03556085
Sponsor's protocol ID
River 1111-001
Status last verified
Jun 2023
First submitted
22 May 2018
Last updated
22 Jun 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Publications

  • Albuquerque FC, Gross BA, Levitt MR. Time to re-assess the treatment of idiopathic intracranial hypertension. J Neurointerv Surg. 2016 Jun;8(6):549-50. doi: 10.1136/neurintsurg-2016-012460. No abstract available.

    PubMed 27178402
  • Abubaker K, Ali Z, Raza K, Bolger C, Rawluk D, O'Brien D. Idiopathic intracranial hypertension: lumboperitoneal shunts versus ventriculoperitoneal shunts--case series and literature review. Br J Neurosurg. 2011 Feb;25(1):94-9. doi: 10.3109/02688697.2010.544781.

    PubMed 21323404
  • Aguilar-Perez M, Martinez-Moreno R, Kurre W, Wendl C, Bazner H, Ganslandt O, Unsold R, Henkes H. Endovascular treatment of idiopathic intracranial hypertension: retrospective analysis of immediate and long-term results in 51 patients. Neuroradiology. 2017 Mar;59(3):277-287. doi: 10.1007/s00234-017-1783-5. Epub 2017 Mar 2.

    PubMed 28255904
  • Ahmed RM, Wilkinson M, Parker GD, Thurtell MJ, Macdonald J, McCluskey PJ, Allan R, Dunne V, Hanlon M, Owler BK, Halmagyi GM. Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictions. AJNR Am J Neuroradiol. 2011 Sep;32(8):1408-14. doi: 10.3174/ajnr.A2575. Epub 2011 Jul 28.

    PubMed 21799038
  • Dinkin MJ, Patsalides A. Venous Sinus Stenting in Idiopathic Intracranial Hypertension: Results of a Prospective Trial. J Neuroophthalmol. 2017 Jun;37(2):113-121. doi: 10.1097/WNO.0000000000000426.

    PubMed 27556959
  • Kanagalingam S, Subramanian PS. Cerebral venous sinus stenting for pseudotumor cerebri: A review. Saudi J Ophthalmol. 2015 Jan-Mar;29(1):3-8. doi: 10.1016/j.sjopt.2014.09.007. Epub 2014 Sep 27.

    PubMed 25859134
  • Dinkin MJ, Patsalides A. Venous Sinus Stenting for Idiopathic Intracranial Hypertension: Where Are We Now? Neurol Clin. 2017 Feb;35(1):59-81. doi: 10.1016/j.ncl.2016.08.006.

    PubMed 27886896

Questions about this trial

What is this clinical trial studying?

A study testing Venous sinus stenting (Serenity River) in people with Idiopathic Intracranial Hypertension, run by Serenity Medical, Inc. at 6 sites in United States.

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 11 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: status not confirmed, as of the sponsor's last update on 22 Jun 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 6 sites in United States. 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?

Major Adverse Event (MAE) (time frame: 12 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 NCT03556085, which also lists 7 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 22 Jun 2023.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in