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Mechanical ThrombectomyNCT03702413

Randomized Controlled Trial of Endovascular Therapy for Acute Large Vessel Occlusion With Large Ischemic Core

A study testing Endovascular treatment in people with Mechanical Thrombectomy and Large Ischemic Core, run by Hyogo Medical University at 1 site in Japan.

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

RESCUE-Japan LIMIT(Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Large IscheMIc core Trial) is a prospective, open label, blinded endpoint (PROBE), Japanese, two-arm, randomized, controlled, post-market study to compare the effectiveness of endovascular treatment as compared to best medical… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Mechanical Thrombectomy, Large Ischemic Core
What is being tested?
Endovascular treatment
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
203 participants
Where
1 siteJapan
Study dates
30 Nov 2018to 30 Mar 2022
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

  • Acute cerebral infarction
  • Age ≥ 18
  • NIHSS ≥ 6
  • Prestroke Modified Rankin Score 0-1
  • ICA or M1 Occlusion on CT angiography or MR angiography
  • ASPECTS 3-5 or DWI-ASPECTS 3-5
Show all 9Show fewer
  • Randamization can be finished within 6 hours from last known well time, or 6 to 24 hours from last well known well time without positive lesion on MRI-FLAIR image.
  • Endovascular treatment can be initiatedwithin 60 minutes from randomization
  • Patient or Legally Authorized Representative has signed the Informed Consent form

Who cannot join

  • Significant mass effect with midline shift
  • Known allergy to contrast agents
  • Evidence of acute intracranial hemorrhage
  • Female who is pregnant or suspicision of pregnant
  • Clinical evidence of chronic occlusion
  • High risk of hemorrhage (platelet < 40,000 /µL, APTT > 50 second or PT-INR > 3.0)
  • Participating in any other therapeutic investigational trial
  • Subjects who, in the judgment of the investigator, are likely to be non-compliant or uncooperative during the study.

Trial locations and contacts

1 site in 1 country.

Japan1 site
  • Hyogo collage of Medicine

    Nishinomiya, Hyōgo, 665-8501

Other trials in Japan

About this study

Official title: Randomized Controlled Trial of Endovascular Therapy for Acute Large Vessel Occlusion With Large Ischemic Core (RESCUE Japan LIMIT)

RESCUE-Japan LIMIT(Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan Large IscheMIc core Trial) is a prospective, open label, blinded endpoint (PROBE), Japanese, two-arm, randomized, controlled, post-market study to compare the effectiveness of endovascular treatment as compared to best medical treatment alone in the acute ischemic stroke patients with an low ASPECTS (CT-ASPECTS 3-5 or DWI-ASPECTS 3-5).

The purpose of this study is to investigate the efficacy of endovascular treatment for acute large vessel occlusion with large ischemic core (CT-ASPECT score 3-5 or DWI-ASPECT score 3-5).

Read the detailed description

In the American Heart Association guideline 2018, endovascular therapy (EVT) has been strongly recommended as class of recommendation (COR) I for for the patients with acute cerebral large vessel occlusion (LVO), the Alberta Stroke Program Early CT Score (ASPECTS) 6 or more. The efficacy of EVT for the patients with low ASPECTS remains unclear.

This study is a prospective, open label, blinded endpoint (PROBE), Japanese, two-arm, randomized, controlled, post-market study to compare the effectiveness of endovascular treatment as compared to best medical treatment alone for acute large vessel occlusion patients with large ischemic core (ASPECTS 3-5 or DWI-ASPECTS 3-5).

Up to 200 subjects will be enrolled in the study and randomized for the Intention to treat analysis set. The randomization will be stratified by treatment institutes, patient's age (less than 75 years old or not), time from symptom onset (0-2 hours or more than 2 hours), and stroke severity (NIHSS 21 or more/less than 21), and administration of rt-PA.

Subjects who meet the inclusion criteria will be randomized in a 1:1 ratio to one of the following two treatment arms: Arm 1: best medical treatment Arm 2: best medical treatment plus endovascular treatment

Primary outcome of this study is to investigate efficacy of endivascular treatment in acute stroke patients with large ischemic core (ASPECTS 3-5 or DWI-ASPECTs 3-5) as compared to best medical treatment alone.

Approximately 40 sites in Japan Patients presenting with acute ischemic stroke (AIS) based on focal occlusion in the M1 segment of the middle cerebral artery (MCA), and/or the intracranial segment of the distal internal carotid artery (ICA), determined by Magnetic Resonance Angiography (MRA) or Computed Tomographic Angiography (CTA), and who meet all eligibility criteria will be considered for study enrollment.

Being tested
Endovascular treatment
Keywords
Acute cerebral infarction due to large vessel occlusion, Mechanical thrombectomy, Ischemic stroke
Medical subject headings
Ischemic Stroke

What participants receive

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

  • Endovascular treatmentProcedure or surgery

    Acute thrombectomy

Study groups in NCT03702413
Study groupRoleWhat they receive
Best medical treatmentNo interventionBest medical treatment
Endovascular treatmentExperimentalBest medical treatment plus endovascular treatment
Receives: Procedure: Endovascular treatment

What is being measured

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

  1. modified Rankin Scale ≤3 at 90 days

    The primary endpoint of the trial is the modified Rankin Scale (mRS) ≤3 at 90 days post-stroke.The scale runs from 0-6 with 0 being perfect health without symptoms to 6 being 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 a符airs 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 a悦ention, bedridden, incontinent.
    6. Dead.

    Measured: 90 days

Secondary outcomes (9)
  1. modified Rankin Scale≤2 at 90 days

    Functional independence as difined by modified Rankin ScalemRS≤2 at 90 days

    Measured: 90 days

  2. modified Rankin Scale≤1 at 90 days

    Excellent outcome as difined by modified Rankin Scale≤1 at 90 days

    Measured: 90 days

  3. Distribution of patients across the ordinal modified Rankin scale

    The difference in linear trends in ordinal mRS outcomes between treatment groups (mRS shift analysis)

    Measured: 90 days

  4. NIHSS improvement 8 points or more at 48 hours

    Early improvement of neulogical findings

    Measured: 48 hours

  5. Symptomatic intracranial hemorrhage within 48 hours

    Defined as NIHSS worsening of 4 or more points associated with ICH within 48 hours of randomization

    Measured: 48 hours

  6. Intracranial hemorrhage within 48 hours

    The incidence of hemorrhage

    Measured: 48 hours

  7. Death

    Death due to any cause at 90 days

    Measured: 90 days

  8. Recurrence of cerebral infarction within 90 days

    Recurrence of cerebral infarction

    Measured: 90 days

  9. Propotion of subjects who required decompressive craniectomy within 7 days

    Propotion of subjects who had space-occupying infarction (malignant brain edema) and requred decompressive craniectomy within 7 days

    Measured: 7 days

Timeline

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

  1. First posted11 Oct 2018
  2. Study start30 Nov 2018
  3. Primary completion21 Dec 2021
  4. Study completion30 Mar 2022

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
203 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03702413
Sponsor's protocol ID
R000038184
Status last verified
Jul 2022
First submitted
4 Oct 2018
Last updated
12 Jul 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Tanaka K, Yoshimoto T, Koge J, Yamagami H, Imamura H, Sakai N, Uchida K, Beppu M, Matsumaru Y, Matsumoto Y, Kimura K, Ishikura R, Inoue M, Sakakibara F, Morimoto T, Yoshimura S, Toyoda K; RESCUE-Japan LIMIT Investigators. Detrimental Effect of Acute Hyperglycemia on the Outcomes of Large Ischemic Region Stroke. J Am Heart Assoc. 2024 Dec 3;13(23):e034556. doi: 10.1161/JAHA.124.034556. Epub 2024 Nov 22.

    PubMed 39575760
  • Inoue M, Yoshimoto T, Yamagami H, Toyoda K, Sakai N, Matsumaru Y, Matsumoto Y, Kimura K, Ishikura R, Uchida K, Beppu M, Sakakibara F, Morimoto T, Yoshimura S; RESCUE-Japan LIMIT Investigators. Expanding the Treatable Imaging Profile in Patients With Large Ischemic Stroke: Subanalysis From a Randomized Clinical Trial. Stroke. 2024 Jul;55(7):1730-1738. doi: 10.1161/STROKEAHA.124.046828. Epub 2024 May 28.

    PubMed 38804134
  • Shindo S, Uchida K, Yoshimura S, Sakai N, Yamagami H, Toyoda K, Matsumaru Y, Matsumoto Y, Kimura K, Ishikura R, Inoue M, Sakakibara F, Nakajima M, Ueda M, Morimoto T. Intravenous alteplase before endovascular therapy for acute large vessel occlusion with large ischemic core: subanalysis of a randomized clinical trial. J Neurointerv Surg. 2024 Oct 14;16(11):1094-1100. doi: 10.1136/jnis-2023-020846.

    PubMed 37890987
  • Ospel JM, Kunz WG, McDonough RV, Goyal M, Uchida K, Sakai N, Yamagami H, Yoshimura S; RESCUE-Japan LIMIT Investigators. Cost-effectiveness of Endovascular Treatment for Acute Stroke with Large Infarct: A United States Perspective. Radiology. 2023 Oct;309(1):e223320. doi: 10.1148/radiol.223320.

    PubMed 37787675
  • Namitome S, Uchida K, Shindo S, Yoshimura S, Sakai N, Yamagami H, Toyoda K, Matsumaru Y, Matsumoto Y, Kimura K, Ishikura R, Inoue M, Beppu M, Sakakibara F, Shirakawa M, Ueda M, Morimoto T; RESCUE-Japan LIMIT Investigators. Number of Passes of Endovascular Therapy for Stroke With a Large Ischemic Core: Secondary Analysis of RESCUE-Japan LIMIT. Stroke. 2023 Aug;54(8):1985-1992. doi: 10.1161/STROKEAHA.123.042552. Epub 2023 Jul 7.

    PubMed 37417239
  • Uchida K, Shindo S, Yoshimura S, Toyoda K, Sakai N, Yamagami H, Matsumaru Y, Matsumoto Y, Kimura K, Ishikura R, Yoshida A, Inoue M, Beppu M, Sakakibara F, Shirakawa M, Morimoto T; RESCUE-Japan LIMIT Investigators. Association Between Alberta Stroke Program Early Computed Tomography Score and Efficacy and Safety Outcomes With Endovascular Therapy in Patients With Stroke From Large-Vessel Occlusion: A Secondary Analysis of the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism-Japan Large Ischemic Core Trial (RESCUE-Japan LIMIT). JAMA Neurol. 2022 Dec 1;79(12):1260-1266. doi: 10.1001/jamaneurol.2022.3285.

    PubMed 36215044
  • Yoshimura S, Sakai N, Yamagami H, Uchida K, Beppu M, Toyoda K, Matsumaru Y, Matsumoto Y, Kimura K, Takeuchi M, Yazawa Y, Kimura N, Shigeta K, Imamura H, Suzuki I, Enomoto Y, Tokunaga S, Morita K, Sakakibara F, Kinjo N, Saito T, Ishikura R, Inoue M, Morimoto T. Endovascular Therapy for Acute Stroke with a Large Ischemic Region. N Engl J Med. 2022 Apr 7;386(14):1303-1313. doi: 10.1056/NEJMoa2118191. Epub 2022 Feb 9.

    PubMed 35138767

Questions about this trial

What is this clinical trial studying?

A study testing Endovascular treatment in people with Mechanical Thrombectomy and Large Ischemic Core, run by Hyogo Medical University at 1 site in Japan.

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 9 inclusion and 8 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 12 Jul 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Japan. 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

modified Rankin Scale ≤3 at 90 days (time frame: 90 days). 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 NCT03702413, 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 12 Jul 2022.

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