Intracerebral HemorrhagePhase 2/3SMADNCT07162363
Synergistic Minimally Invasive Surgery and Deferoxamine in ICH
A Phase 2/3 study testing Minimally Invasive surgery (MIS), Deferoxamine and Standard Medical Care (SMD) in people with Intracerebral Hemorrhage and ICH - Intracerebral Hemorrhage, run by University of Illinois Chicago at 1 site in United States.
Trial summary
This is a multicenter, randomized, open-label trial designed to evaluate the safety, feasibility, and efficacy of combining minimally invasive surgery (MIS) with intravenous deferoxamine (DFX) for the treatment of spontaneous intracerebral hemorrhage (ICH), compared to standard medical care. Read more about this study
- Who is it for?
- Ages 18 to 80 years
- Conditions the study is for
- Intracerebral Hemorrhage, ICH - Intracerebral Hemorrhage
- What is being tested?
- Minimally Invasive surgery (MIS), Deferoxamine and Standard Medical Care (SMD)
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 240 participants
- Where
- 1 siteUnited States
- Study dates
- 1 Mar 2026to 30 Dec 2028
- Phase
- Phase 2/3
- Are there results?
- Not yet: the study is under way
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 80 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Participants must meet all the following criteria:
- Age ≥ 18 and ≤ 80 years
- Spontaneous supratentorial ICH confirmed by CT or CTA, with hematoma volume:
- ≥30 mL on initial diagnostic CT, OR
- ≥25 mL on stability CT performed ≥6 hours after diagnostic CT,
- Clot growth must be less than 5 mL between scans to be eligible
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- A second stability scan at least 12 hours later is allowed if clot expanded >5 mL
- NIHSS score ≥ 6 at enrollment
- Glasgow Coma Scale (GCS) score ≥5 and ≤14 at screening
- Symptoms onset ≤ 24 hours before diagnostic CT
- Use "last known well" for wake-up strokes
- Unknown onset is exclusionary
- SBP < 180 mm Hg sustained for at least 6 hours prior to randomization
- Randomization must occur between 12 and 24 hours from initial diagnostic CT done at UIC or in case of transfers, at other institutions.
- Functionally independent pre-ICH, defined as mRS 0-1. Pre-ICH functional status will be determined from medical records and structured interviews with the patient or a reliable caregiver, with ambiguous cases adjudicated by the site PI. Patients with mRS 0-1 are considered functionally independent, able to perform all usual activities without assistance.
- Written informed consent obtained from patient or legal representative
Who cannot join
- Infratentorial hemorrhage (e.g., brainstem or cerebellar hematoma).
- Hemorrhage due to secondary causes: trauma, AVM, aneurysm, Moyamoya disease, hemorrhagic conversion of ischemic stroke, tumor, or vascular anomaly (diagnosed on imaging).
- Recurrent ICH within the past year.
- Intraventricular hemorrhage (IVH) requiring surgical treatment for trapped ventricle or mass effects (e.g., endoscopic evacuation). EVD is permitted.
- Evidence of irreversible impaired brainstem function (e.g., bilateral fixed dilated pupils, decerebrate posturing).
- Glasgow Coma Scale (GCS) ≤ 4 at screening, indicating extremely poor neurologic prognosis. NIHSS item 1a = 3, indicating comatose status (unresponsive to verbal or painful stimulation).
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- Thalamic ICH with midbrain extension and third nerve palsy.
- Clinical indication for emergent surgical hematoma evacuation, as determined by treating neurosurgeons.
- NIHSS score < 6 (too mild to benefit).
- Expected withdrawal of care or death within 72 hours.
- Prior enrollment in the study.
- Creatinine ≥ 2.0 mg/dL or evidence of severe renal impairment.
- Active hepatic failure or severe hepatic disease.
- Pregnancy or breastfeeding.
- Severe iron deficiency anemia (Hgb < 8 g/dL or ferritin <15 ng/mL).
- Active systemic infection (e.g., sepsis, subacute bacterial endocarditis).
- Active internal bleeding (GI, GU, retroperitoneal, pulmonary).
- History of mechanical heart valve (bioprosthetic valves allowed).
- Known left atrial/ventricular thrombus or high embolic risk (e.g., mitral stenosis + AFib).
- Any coagulopathy:
- Platelet count <100,000
- INR > 1.4 not correctable within 6 hours
- Use of NOACs (apixaban, rivaroxaban, dabigatran) or LMWH at presentation
- Long-term anticoagulation that cannot be stopped safely (e.g., mechanical valve needing Coumadin).
- Allergy or intolerance to DFX or rtPA.
- Active alcohol or drug use that impairs adherence to follow-up.
- Participation in another interventional trial. (Observational studies are allowed.
- Inability or unwillingness to provide informed consent. This includes patients who lack decision-making capacity (and have no available legally authorized representative) or those who decline participation.
- Not expected to survive to Day 365 or have DNR/DNI status at time of screening.
- Any other condition that the investigator believes would pose a significant hazard or interfere with outcome assessments.
- Patients with confirmed aspiration, pneumonia, pulmonary edema, evident bilateral pulmonary infiltrates on CXR or CT scan prior to enrollment.
- Patients with significant respiratory disease such as chronic obstructive pulmonary disease, pulmonary fibrosis, or any use of chronic or intermittent inhaled O2 at home.
- The presence of 4 or more of the following risk modifiers for ARDS prior to enrollment:
- Tachypnea (respiratory rate >30)
- SpO2 <95%
- Obesity, defined as Body Mass Index (BMI) >30 d) Acidosis (pH <7.35)
- Hypoalbuminemia (albumin <3.5 g/dL) f. Concurrent use of chemotherapy
- Subjects who are taking prochlorperazine or are expected to undergo Gallium-67 imaging during the study period.
- Known severe hearing loss.
- Taking iron supplements containing ≥325 mg ferrous iron or prochlorperazine 34. Patients with heart failure taking >500 mg vitamin C daily
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
United States1 site
University of Illinois Hospital & Health Sciences System (UI Health)
Chicago, Illinois, 60612
Gursant S. Atwal, MD, 312-996-4842, gatwal@uic.edu
Javed Iqbal, MBBS, 312-996-4842, jiqbal3@uic.edu
About this study
Official title: Synergistic Intervention of Minimally Invasive Surgery and Deferoxamine in Intracerebral Hemorrhage (SMAD)
This is a multicenter, randomized, open-label trial designed to evaluate the safety, feasibility, and efficacy of combining minimally invasive surgery (MIS) with intravenous deferoxamine (DFX) for the treatment of spontaneous intracerebral hemorrhage (ICH), compared to standard medical care.
This trial represents the first investigation of a dual-modality approach in ICH, integrating mechanical clot evacuation with biochemical neuroprotection, with the goal of improving neurological outcomes.
- Being tested
- Minimally Invasive surgery (MIS), Deferoxamine, Standard Medical Care (SMD)
- Keywords
- deferoxamine, DFX, MIS, minimally invasive surgery, alteplase, ICH, Intracerebral hemorrhage
- Medical subject headings
- Cerebral Hemorrhage
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Minimally Invasive surgery (MIS)Procedure or surgery
Lobar (superficial) hematomas will be evacuated via a minimally invasive trans-sulcal parafascicular approach, whereas deep hematomas will be removed through a minimally invasive burr-hole approach with catheter placement to allow controlled clot dissolution using alteplase.
DeferoxamineDrug
Also called Deferoxamine mesylate, Desferal
Deferoxamine will be administered as a continuous intravenous infusion at a dose of 32 mg/kg/day over 24 hours for a total of 3 consecutive days.
Standard Medical Care (SMD)Other
We will follow the American Heart Association and European Stroke Organization guidelines for the management of non-traumatic spontaneous intracerebral hemorrhage, ensuring a standardized approach to monitoring patients' airways, ventilation, intracranial pressure, sedation, and pharmacologic management of intracranial mass effect.
| Study group | Role | What they receive |
|---|---|---|
| MIS and IV Deferoxamine | Experimental | Patients in the investigational arm will receive intravenous deferoxamine (DFX) at 32 mg/kg per day, initiated within 1 hour of randomization and continued for 3 consecutive days. Once the hematoma is deemed stable for intervention, the MIS procedure will involve hematoma evacuation using different techniques tailored for superficial (lobar) and deep hemorrhages within 24 hours of Ictus. Receives: Procedure: Minimally Invasive surgery (MIS); Drug: Deferoxamine |
| Standard Medical Care (SMC) | Active comparator | Participants will receive standard medical management for ICH without MIS or deferoxamine, serving as the control group. Receives: Other: Standard Medical Care (SMD) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Utility-weighted Modified Rankin Scale (mRS)
The Modified Rankin Scale (mRS) is a standard measure of global disability after stroke or intracerebral hemorrhage. For this study, a utility-weighted mRS (uw-mRS) will be used to account for patient-centered quality-of-life differences across mRS levels. Higher utility scores indicate better functional outcomes. The uw-mRS will be assessed at Days 30, 90, and 180 after randomization to evaluate the long-term impact of the intervention on patient functional recovery.
Measured: Post-randomization day 30, day 90, day 180
Rate of All-Cause Mortality
Percentage of participants who died from any cause within the first 30 days after randomization.
Measured: Post-randomization day 30
Rate of Procedure-Related Mortality
Percentage of participants who died due to the study procedures within the first 7 days after randomization.
Measured: Post-randomization day 7
Rate of Infectious Complications
Percentage of participants who developed a bacterial brain infection (cerebritis, meningitis, or ventriculitis) within 30 days of randomization.
Measured: Post-randomization day 30
Other Adverse Events
Percentage of participants experiencing adverse events related to allergic reactions, cardiovascular events (hypotension, tachycardia), renal or hepatic dysfunction, or seizures.
Measured: Post-randomization day 30
Rate of Procedural Complications
Percentage of participants with cerebrospinal fluid (CSF) leaks or other surgery-related complications requiring intervention.
Measured: Post-randomization day 30
Rate of Symptomatic Intracranial Hemorrhage
Percentage of participants experiencing symptomatic rebleeding or hematoma expansion within 7 days of post-randomization.
Measured: Post-randomization day 7
Secondary outcomes (3)
Hematoma and Edema Volume on Imaging
Early Treatment Response: Percentage of hematoma resolved at the end-of-treatment CT scan compared with the stability CT scan performed prior to randomization.
Follow-Up Assessment: Percentage of hematoma and perihematomal edema resolved on CT scans performed at 30, 90, and 180 days compared with both the stability CT scan and the end-of-treatment CT scan.
Measured: From randomization until end of treatment (up to 10 days) for early response, and at 30-, 90-, and 180-days post-randomization for follow-up assessments.
Intensive Care Unit (ICU) and Hospital Length of Stay
Total length of initial ICU and hospital stay within 3 months after randomization
Measured: Within 3 months after randomization
Mortality
Measured: Post-treatment day 180
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 Sep 2025
- Study start1 Mar 2026 (estimated)
- Primary completion30 Dec 2028 (estimated)
- Study completion30 Dec 2028 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Intracerebral HemorrhageStudies of the same condition, open and under way.
- More trials run by University of Illinois ChicagoThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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 2/3
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 240 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of Illinois Chicago
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Gursant S. Atwal, MD, Principal investigator, University of Illinois Hospital & Health Sciences System (UI Health)Javed Iqbal, MBBS, Study director, University of Illinois Hospital & Health Sciences System (UI Health)
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07162363
- Sponsor's protocol ID
- STUDY2025-0922
- Acronym
- SMAD
- Status last verified
- Oct 2025
- First submitted
- 19 Aug 2025
- Last updated
- 10 Oct 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Study at a glance
From the registry record, last updated by the sponsor on 10 Oct 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Synergistic Intervention of Minimally Invasive Surgery and Deferoxamine in Intracerebral Hemorrhage (SMAD)
- ClinicalTrials.gov ID
- NCT07162363
- Acronym / sponsor ID
- SMAD / STUDY2025-0922
- Keywords
- deferoxamine, DFX, MIS, minimally invasive surgery, alteplase, ICH, Intracerebral hemorrhage
- Phase
- Phase 2/3
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 240 participants (estimated)
- Lead sponsor
- University of Illinois ChicagoUniversity, hospital or other
- Study start
- 1 Mar 2026 (estimated)
- Primary completion
- 30 Dec 2028 (estimated)
- Study completion
- 30 Dec 2028 (estimated)
- First posted
- 9 Sep 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This is a multicenter, randomized, open-label trial designed to evaluate the safety, feasibility, and efficacy of combining minimally invasive surgery (MIS) with intravenous deferoxamine (DFX) for the treatment of spontaneous intracerebral hemorrhage (ICH), compared to standard medical care.
This trial represents the first investigation of a dual-modality approach in ICH, integrating mechanical clot evacuation with biochemical neuroprotection, with the goal of improving neurological outcomes.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| MIS and IV Deferoxamine | Experimental | Procedure: Minimally Invasive surgery (MIS), Drug: DeferoxaminePatients in the investigational arm will receive intravenous deferoxamine (DFX) at 32 mg/kg per day, initiated within 1 hour of randomization and continued for 3 consecutive days. Once the hematoma is deemed stable for intervention, the MIS procedure will involve hematoma evacuation using different techniques tailored for superficial (lobar) and deep hemorrhages within 24 hours of Ictus. |
| Standard Medical Care (SMC) | Active comparator | Other: Standard Medical Care (SMD)Participants will receive standard medical management for ICH without MIS or deferoxamine, serving as the control group. |
Who may qualify
- Ages
- 18 to 80 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (16 listed)
- Age ≥ 18 and ≤ 80 years
- Spontaneous supratentorial ICH confirmed by CT or CTA, with hematoma volume:
- NIHSS score ≥ 6 at enrollment
- Glasgow Coma Scale (GCS) score ≥5 and ≤14 at screening
- Symptoms onset ≤ 24 hours before diagnostic CT
Key exclusion criteria (40 listed)
- Infratentorial hemorrhage (e.g., brainstem or cerebellar hematoma).
- Hemorrhage due to secondary causes: trauma, AVM, aneurysm, Moyamoya disease, hemorrhagic conversion of ischemic stroke, tumor, or vascular anomaly (diagnosed on imaging).
- Recurrent ICH within the past year.
- Intraventricular hemorrhage (IVH) requiring surgical treatment for trapped ventricle or mass effects (e.g., endoscopic evacuation). EVD is permitted.
- Evidence of irreversible impaired brainstem function (e.g., bilateral fixed dilated pupils, decerebrate posturing).
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Minimally Invasive surgery (MIS)Lobar (superficial) hematomas will be evacuated via a minimally invasive trans-sulcal parafascicular approach, whereas deep hematomas will be removed through a minimally invasive burr-hole approach with catheter placement to allow controlled clot dissolution using alteplase. | Procedure or surgery | MIS and IV Deferoxamine |
| DeferoxamineAlso: Deferoxamine mesylate, DesferalDeferoxamine will be administered as a continuous intravenous infusion at a dose of 32 mg/kg/day over 24 hours for a total of 3 consecutive days. | Drug | MIS and IV Deferoxamine |
| Standard Medical Care (SMD)We will follow the American Heart Association and European Stroke Organization guidelines for the management of non-traumatic spontaneous intracerebral hemorrhage, ensuring a standardized approach to monitoring patients' airways, ventilation, intracranial pressure, sedation, and pharmacologic management of intracranial mass effect. | Other | Standard Medical Care (SMC) |
Primary outcome
Utility-weighted Modified Rankin Scale (mRS)
Time frame: Post-randomization day 30, day 90, day 180
The Modified Rankin Scale (mRS) is a standard measure of global disability after stroke or intracerebral hemorrhage. For this study, a utility-weighted mRS (uw-mRS) will be used to account for patient-centered quality-of-life differences across mRS levels. Higher utility scores indicate better functional outcomes. The uw-mRS will be assessed at Days 30, 90, and 180 after randomization to evaluate the long-term impact of the intervention on patient functional recovery.
Rate of All-Cause Mortality
Time frame: Post-randomization day 30
Percentage of participants who died from any cause within the first 30 days after randomization.
Rate of Procedure-Related Mortality
Time frame: Post-randomization day 7
Percentage of participants who died due to the study procedures within the first 7 days after randomization.
Rate of Infectious Complications
Time frame: Post-randomization day 30
Percentage of participants who developed a bacterial brain infection (cerebritis, meningitis, or ventriculitis) within 30 days of randomization.
Other Adverse Events
Time frame: Post-randomization day 30
Percentage of participants experiencing adverse events related to allergic reactions, cardiovascular events (hypotension, tachycardia), renal or hepatic dysfunction, or seizures.
Rate of Procedural Complications
Time frame: Post-randomization day 30
Percentage of participants with cerebrospinal fluid (CSF) leaks or other surgery-related complications requiring intervention.
Rate of Symptomatic Intracranial Hemorrhage
Time frame: Post-randomization day 7
Percentage of participants experiencing symptomatic rebleeding or hematoma expansion within 7 days of post-randomization.
3 secondary outcomes
Hematoma and Edema Volume on Imaging
Time frame: From randomization until end of treatment (up to 10 days) for early response, and at 30-, 90-, and 180-days post-randomization for follow-up assessments.
Intensive Care Unit (ICU) and Hospital Length of Stay
Time frame: Within 3 months after randomization
Mortality
Time frame: Post-treatment day 180
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Oct 2025.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Gursant S. Atwal, MD principal investigator
University of Illinois Hospital & Health Sciences System (UI Health)
Javed Iqbal, MBBS study director
University of Illinois Hospital & Health Sciences System (UI Health)
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 2/3 study testing Minimally Invasive surgery (MIS), Deferoxamine and Standard Medical Care (SMD) in people with Intracerebral Hemorrhage and ICH - Intracerebral Hemorrhage, run by University of Illinois Chicago at 1 site 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 16 inclusion and 40 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: opening soon, as of the sponsor's last update on 10 Oct 2025. 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 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.
What does this combined 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.
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Gursant S. Atwal, MD (312-996-4842, gatwal@uic.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Utility-weighted Modified Rankin Scale (mRS) (time frame: Post-randomization day 30, day 90, day 180). The study lists 7 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 10 Oct 2025.