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Acute Ischemic Stroke (AIS) Related to a Distal OcclusionDISCOUNTNCT05030142

Evaluation of Mechanical Thrombectomy in Acute Ischemic Stroke Related to a Distal Arterial Occlusion

A study testing Mechanical Thrombectomy and Best medical treatment alone in people with Acute Ischemic Stroke (AIS) Related to a Distal Occlusion, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

Mechanical thrombectomy (MT) has shown its effectiveness for the treatment of acute ischemic stroke (AIS) related to large vessel occlusion and rapidly became a cornerstone in the management of these patients. No strong evidence is available on the benefit of MT in AIS related to more distal occlusions. Read more about this study

Who is it for?
Ages 18 years and older
What is being tested?
Mechanical Thrombectomy and Best medical treatment alone
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
488 participants
Where
1 siteFrance
Study dates
14 Nov 2021to 14 Feb 2024
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

  • Patients aged ≥ 18 years
  • Delay between symptoms onset and expected groin puncture ≤ 6 h
  • Symptomatic occlusion as evaluated by a National Institute of Health Stroke Score (NIHSS) ≥ 5
  • Distal occlusion evaluated on CT angiography (CTA) or magnetic resonance imaging (MRI) and defined as an occlusion in one of the following segments:
  • Distal M2, above the mid-height of the insula
  • M3 segment
Show all 9Show fewer
  • Posterior cerebral artery (PCA): P1, P2, P3 segments
  • Anterior cerebral artery (ACA): A1, A2, A3 segments
  • Written informed consent signed by the patient or the trustworthy person / family member / close relative, or inclusion in case of emergency and written informed consent will be signed by the patient (if needed by trustworthy person, family member or close relative) as soon as possible (article L1122-1-2 of the French Public Health Code)

Who cannot join

  • Pregnancy or breastfeeding woman
  • Contra-indication for femoral, radial or humeral arterial puncture
  • Tandem occlusion (i.e.: concomitant cervical and intra-cranial arterial occlusion)
  • Allergy to iodinated contrast media
  • Known renal insufficiency (confirmed by previous result of creatinine clearance < 30 ml/min)
  • Secondary distal occlusion (i.e., complicating a MT for a proximal occlusion, or any other endovascular intracranial procedure)
Show all 17Show fewer
  • Aortic dissection
  • Asymptomatic or minor stroke (i.e.: NIHSS < 5)
  • Pretreatment mRS > 1 (pre-stroke)
  • Anticipated limitations for anesthesia
  • Participation in another trial (Jardé 1 and Jardé 2)
  • Absence of affiliation to National French social security system
  • Under legal protection measure (tutorship or curatorship) and patient deprived of freedom
  • A pre-existing hemorrhage in the brain tissue fed by the target vessel
  • Known hypersensitivity to nickel/titanium
  • Stenosis and/or with a stent proximal to the site of the thrombus which could preclude the retrieval of the stent retriever
  • Angiographic evidence of carotid dissection

Trial locations and contacts

1 site in 1 country.

Frédéric Clarençon, Professor contact

+ 33 1 42 16 35 43

frederic.clarencon@aphp.fr

Anne Radenne, Manager contact

+ 33 1 42 16 16 99

anne.radenne@aphp.fr

France1 site, 1 recruiting
  • Frédéric CLARENCON

    Paris, 75013

    Anne RADENNE, 0142161699

    Recruiting

Other trials in France

About this study

Official title: Evaluation of Mechanical Thrombectomy in Acute Ischemic Stroke Related to a Distal Arterial Occlusion: a Randomized Controlled Trial

Mechanical thrombectomy (MT) has shown its effectiveness for the treatment of acute ischemic stroke (AIS) related to large vessel occlusion and rapidly became a cornerstone in the management of these patients. No strong evidence is available on the benefit of MT in AIS related to more distal occlusions. Some previous observational studies suggested a possible benefit but most of them were single-centre and retrospective studies providing a very low level of evidence. To date, no randomized controlled trial has been conducted in this indication, which represents 10% to 20% of all AIS involving intracranial vessel occlusions.

This research is a multicenter open randomized controlled trial with two parallel groups : best medical treatment alone VS mechanical trombectomy + best medical treatment.

Read the detailed description

The main objective of this trial is to assess the efficacy of mechanical thrombectomy in addition to the best medical treatment as compared to the best medical treatment alone in AIS related to a distal intracranial artery occlusion. The medical device used will be a stent retriever among : Trevor NXT ProVue Retriever ; Catchview mini ; pReset Lite ; Tigertriever13, and the medical treatment used will depend on the stroke's etiology and will consist of IV trhombolysis or tenecteplase or antiplatelet therapy or anticoagulant therapy ... The main inclusion criteria are : 1) patients aged ≥ 18 years ; 2) Delay between symptoms onset and expected groin puncture ≤ 6h ; 3) Symptomatic occlusion as evaluated by a National Institute of Health Stroke Score (NIHSS) ≥ 5 ; 4) Distal occlusion evaluated on CT angiography (CTA) or magnetic resonance imaging (MRI) and defined as an occlusion in one of the following segments : a-Distal M2, above the mid-height of the insula, b-M3 segment, c-Posterior cerebral artery (PCA) = P1, P2 or P3 segment, d-Anterior cerebral artery (ACA) : A1, A2 or A3 segment ; 5) Written informed consent signed by the patient or the trustworthy person / family member / close relative, or inclusion in case of emergency and written informed consent will be signed by the patient (if needed by trustworthy person, family member or close relative) as soon as possible (article L1122-1-2 of the French Public Health Code).

The secondary objectives and endpoints are to evaluate the : 1) Success of the procedure defined as recanalization of the occluded vessel, evaluated on the AOL (Arterial Occlusion Lesion) score within 48 hours ; 2) Excellent clinical outcome (defined as a modified Rankin scale [mRS]≤1) at 3 months ; 3) Safety with reporting of all adverse and serious adverse events with a particular attention to perforation rate, embolus migration in a new territory and symptomatic hemorrhagic complications ; 4) Death rate up to 3 months ; 5) Cost effectiveness and utility of the procedure. The study will also evaluate the rate of angiographic reperfusion in the intervention group on the final angiogram at the end of the MT (which is part of the intervention) using the modified thrombolysis in cerebral infarction (mTICI) (2B-3) and the eTICI.

Being tested
Mechanical Thrombectomy, Best medical treatment alone
Keywords
Acute Ischemic Stroke, Distal occlusions, Mechanical Thrombectomy
Medical subject headings
Ischemic Stroke

What participants receive

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

  • Mechanical ThrombectomyProcedure or surgery

    Also called Experimental group

    Mechanical thrombectomy (using a stent retriever among the following:Trevo NXT ProVue Retriever, Catchview mini, pReset Lite, Tigertriever 13) in association with the best medical treatment (usual care)

  • Best medical treatment aloneDrug

    Also called Control group

    Best medical treatment alone (usual care)

Study groups in NCT05030142
Study groupRoleWhat they receive
Mechanical thrombectomyExperimentalMechanical thrombectomy (using a stent retriever among the following:Trevo NXT ProVue Retriever, Catchview mini, pReset Lite, Tigertriever 13) in association with the best medical treatment (usual care)
Receives: Procedure: Mechanical Thrombectomy
Active ComparatorActive comparatorBest medical treatment alone (usual care)
Receives: Drug: Best medical treatment alone

What is being measured

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

  1. Good clinical outcome (defined as a modified Rankin Scale [mRS] ≤ 2)

    mRS of 0-2 (evaluated by an independent assessor blinded to the intervention received by the patient)

    Measured: At 3 months

Secondary outcomes (12)
  1. Recanalization of the occluded vessel

    Evaluation of AOL (Arterial Occlusion Lesion scale) ≥ 2 on vascular brain imaging (magnetic resonance MR) or computed tomography (CT) angiography in patients belonging to both arms

    Measured: 48 hours after the mechanical thrombectomy

  2. Angiographic reperfusion in the intervention group

    Use of the mTICI score (successful reperfusion: mTICI 2b-3) and the eTICI (extended thrombolysis in cerebral infarction) score (successful reperfusion: eTICI ≥ 2b67) on the control digital subtraction angiography (DSA)

    Measured: End of the mechanical thrombectomy procedure

  3. Excellent Clinical outcome (defined as a modified Rankin Scale [mRS] ≤ 1)

    mRS of 0-1 (evaluated by an independent assessor blinded to the intervention received by the patient)

    Measured: At 3 months

  4. Perforation rate

    Defined as contrast material extravasation either on digital subtraction angiography [DSA] or control CT scan

    Measured: End of mechanical thrombectomy procedure

  5. Embolus migration in a new territory

    evaluated on digital subtraction angiography [DSA]

    Measured: End of mechanical thrombectomy procedure

  6. Symptomatic intracranial hemorrhage

    evaluated on CT-scan or MRI according to the ECASS II criteria

    Measured: within 7 days

  7. Subarachnoid hemorrhage

    evaluated on CT-scan or MRI and define as the abnormal presence of blood within the subarachnoid space presence of blood within the subarachnoid space

    Measured: within 48 hours

  8. Safety : incidence of adverse events

    Reporting of all adverse events

    Measured: At 3 months

  9. Safety : incidence of serious adverse events

    Reporting of all serious adverse events

    Measured: At 3 months

  10. Death rate

    Mortality

    Measured: At 3 months

  11. Utility of the procedure

    Incremental cost utility ratio

    Measured: At 3 months

  12. Cost effectiveness

    Cost per additional survivor (health-economics analysis)

    Measured: At 3 months

Timeline

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

  1. First posted1 Sep 2021
  2. Study start14 Nov 2021
  3. Primary completion14 Feb 2024 (estimated)
  4. Study completion14 Feb 2024 (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
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
488 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05030142
Sponsor's protocol ID
APHP200028
Other IDs
2021-A00516-35
Acronym
DISCOUNT
Status last verified
Apr 2023
First submitted
31 Jul 2021
Last updated
18 Apr 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Data are available upon reasonable request. The procedures carried out with the French data privacy authority (CNIL, Commission nationale de l'informatique et des libertés) do not provide for the transmission of the database, nor do the information and consent documents signed by the patients. Consultation by the editorial board or interested researchers of individual participant data that underlie the results reported in the article after deidentification may nevertheless be considered, subject to prior determination of the terms and conditions of such consultation and in respect for compliance with the applicable regulations.

Publications

  • Clarencon F, Bala F, Baptiste A, Pasi M, Marnat G, Sibon I, Gory B, Richard S, Pop R, Wolff V, Fauche C, Lamy M, Costalat V, Arquizan C, Rodriguez-Regent C, Turc G, Cognard C, Fontaine L, Di Maria F, Lapergue B, Bricout N, Henon H, Tuilier T, Wittwer A, Alexandre PL, De Gaalon S, Spelle L, Denier C, Chabert E, Ferrier A, Rouchaud A, Macian-Montoro F, Soize S, Moulin S, Boisseau W, Sabben C, Barbier C, Boulanger M, Eker OF, Cho TH, Gentric JC, Timsit S, Labeyrie MA, Reiner P, Pico F, Durand-Zaleski I, Alamowitch S, Dechartres A; DISCOUNT Investigators. Mechanical Thrombectomy in Ischemic Stroke With a Medium or Distal Arterial Occlusion: The DISCOUNT Randomized Clinical Trial. JAMA. 2026 Jul 22:e268977. doi: 10.1001/jama.2026.8977. Online ahead of print.

    PubMed 42485024
  • Clarencon F, Durand-Zaleski I, Premat K, Baptiste A, Chabert E, Ferrier A, Labeyrie MA, Reiner P, Spelle L, Denier C, Tuilier T, Hosseini H, Rodriguez-Regent C, Turc G, Fauche C, Lamy M, Lapergue B, Consoli A, Barbier C, Boulanger M, Bricout N, Henon H, Gory B, Richard S, Rouchaud A, Macian-Montoro F, Eker O, Cho TH, Soize S, Moulin S, Gentric JC, Timsit S, Darcourt J, Albucher JF, Janot K, Annan M, Pico F, Costalat V, Arquizan C, Marnat G, Sibon I, Pop R, Wolff V, Shotar E, Lenck S, Sourour NA, Radenne A, Alamowitch S, Dechartres A. Evaluation of mechanical thrombectomy in acute ischemic stroke related to a distal arterial occlusion: A randomized controlled trial. Int J Stroke. 2024 Mar;19(3):367-372. doi: 10.1177/17474930231205213. Epub 2023 Oct 12.

    PubMed 37740419

Questions about this trial

What is this clinical trial studying?

A study testing Mechanical Thrombectomy and Best medical treatment alone in people with Acute Ischemic Stroke (AIS) Related to a Distal Occlusion, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

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 17 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 18 Apr 2023. 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 France. 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?

Contact Frédéric Clarençon, Professor (+ 33 1 42 16 35 43, frederic.clarencon@aphp.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Good clinical outcome (defined as a modified Rankin Scale [mRS] ≤ 2) (time frame: At 3 months). 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 NCT05030142, 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 18 Apr 2023; AzTrials last refreshed its copy on 7 Nov 2026.

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