Safety of Rt-PA + Transcranial Emission of Low-Energy Lasers for Acute Stroke Recovery (StELLAR)

This study has been terminated.
(Device sponsor no longer in business.)
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Justin Zivin, University of California, San Diego
ClinicalTrials.gov Identifier:
NCT01220739
First received: October 13, 2010
Last updated: April 20, 2013
Last verified: April 2013
  Purpose

To assess the safety and preliminary efficacy of combining intravenous rt-PA with transcranial laser therapy (TLT) with the NeuroThera® Laser System (referred to hereafter as NTS) in subjects treated for acute ischemic stroke. Treatment with IV rt-PA must begin within 3 hours of symptom onset, and the initiation of TLT procedure must be feasible for each subject within 6 hours of stroke onset. The NeuroThera® Laser System is an investigational device that provides noninvasive transcranial laser therapy to subjects diagnosed with acute ischemic stroke. The wavelength of the laser light is in the infrared zone of the electromagnetic spectrum and is invisible to the naked eye.


Condition Intervention Phase
Ischemic Stroke
Device: transcranial laser therapy
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Safety of Rt-PA + Transcranial Emission of Low-Energy Lasers for Acute Stroke Recovery

Resource links provided by NLM:


Further study details as provided by University of California, San Diego:

Primary Outcome Measures:
  • symptomatic intracerebral hemorrhage [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • Hemorrhagic transformation without clinical consequences (asymptomatic) within 36-48 hours. All follow-up neuroimaging scans will be reviewed centrally by an independent reviewer for the presence or absence of hemorrhage on the 36-48 hour scan. [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]
  • Mortality [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]
  • The modified Rankin Scale (mRS) score dichotomized as 0-1 versus an mRS score of 2-6 at 90 days or the last rating in patients that develop intracerebral hemorrhages [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]
  • Frequency of SAEs and AEs [ Time Frame: 3 months ] [ Designated as safety issue: Yes ]

Enrollment: 12
Study Start Date: June 2011
Study Completion Date: April 2013
Primary Completion Date: December 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: tPA only Device: transcranial laser therapy
The NeuroThera® Laser System (NTS) is used in subjects diagnosed with acute ischemic stroke. A laser system is a medical instrument that concentrates energy light on an area. Laser treatment has been used to deliver intense light energy to aid in the healing of tissues and wounds. The transcranial laser treatment procedure consists of applying the NTS laser to twenty different sites on the skull for two minutes at each site.
Experimental: tPA plus laser Device: transcranial laser therapy
The NeuroThera® Laser System (NTS) is used in subjects diagnosed with acute ischemic stroke. A laser system is a medical instrument that concentrates energy light on an area. Laser treatment has been used to deliver intense light energy to aid in the healing of tissues and wounds. The transcranial laser treatment procedure consists of applying the NTS laser to twenty different sites on the skull for two minutes at each site.

Detailed Description:

This study is a phase II (n= 200), prospective, double-blind, randomized, sham-controlled, multicenter, safety study of intravenous (IV) rt-PA alone versus IV rt-PA plus TLT (Transcranial Laser Therapy) at approximately 10 investigational sites (United States only). The primary endpoint for this safety study is occurrence of symptomatic intracranial hemorrhages at 36 - 48 hours after stroke symptom onset.

Symptomatic hemorrhage will be defined as deterioration of more than 4 points on the NIHSS lasting at least 72 hours accompanied by intracranial hemorrhage in the distribution of the neurological deficit as identified by neuroimaging scans. All follow up neuroimaging scans will be reviewed centrally by an independent reviewer for the presence or absence of hemorrhage on the 36-48 hour scan.

The secondary endpoints for this study are as follows:

  • Hemorrhagic transformation without clinical consequences (asymptomatic) within 36-48 hours. All follow-up neuroimaging scans will be reviewed centrally by an independent reviewer for the presence or absence of hemorrhage on the 36-48 hour scan.
  • Mortality
  • The modified Rankin Scale (mRS) score dichotomized as 0-1 versus an mRS score of 2-6 at 90 days or the last rating in patients that develop intracerebral hemorrhages
  • Frequency of SAEs and AEs This study is a phase II (N = 200), prospective, double-blind, randomized, sham controlled, multicenter, safety study of intravenous (IV) tissue plasminogen activator (rt-PA) versus IV rt-PA plus transcranial laser therapy (TLT) at approximately 10 investigational sites.

The study population will be randomized into two arms. One group will receive a sham TLT procedure (Sham Control Group or SCG) and the second group will receive an active TLT procedure (TLTG).

The randomization ratio of SCG and TLTG will be 1:1 and will be stratified in order to ensure balanced subject distribution between the treatment and sham-controlled groups for the following factors:

  • Stroke severity as measured by National Institute of Health Stroke Scale (NIHSS) at baseline (stratified as 7-9, 10-13, 14-17)
  • Study Site There are 6 visits in the study. The purpose of the Visit 1 will be to determine and confirm the eligibility of patients for participation in the StELLAR Study and document baseline information about the subject and their stroke event. This will include all of the following standard of care tests and procedures: a non contrast head CT scan performed prior to rt-PA administration, vital signs, height , weight ,physical exam, finger stick or blood glucose, serum or urine pregnancy test (if women of childbearing potential). In addition, the following data will be obtained: prestroke mRS, NIHSS, presumed location of stroke and vascular territory, start and stop date and time of the IV rt-PA treatment and dose given, date and time of stroke onset, date and time of arrival to the hospital, demographic data (date of birth, gender, ethnicity),sociodemographic data (education, marital status, social support prior to stroke),medical and surgical history (specific cardiovascular, neurological, endocrine, and other standard questions asked), method of contraception use (for women of child bearing potential), prior (three days prior to Screening) and current concomitant medication use, smoking history, adverse events from the time of obtaining informed consent. To be eligible for the study, the administration of rt-PA should follow the guidelines outlined by the National Institutes of Neurologic Disorders. Patients meeting the inclusion/exclusion criteria will be enrolled into the study after written informed consent is obtained by the patient or their legally authorized representative.
  Eligibility

Ages Eligible for Study:   18 Years to 80 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

Subjects may be included in the study only if they meet all of the following criteria:

  1. Subject is at least 40 years of age at screening, but has not had their 81st birthday.
  2. Subject has received IV rt-PA per the NINDS rt-PA Protocol Guidelines within 3 hours of symptom onset for an acute ischemic stroke.
  3. Subject is diagnosed with acute ischemic stroke and presents to the health care facility at a time such that initiation of NTS procedure is feasible within 6 hours of the time of stroke onset. The time of stroke onset is defined as the time at which a change in the baseline neurological function occurred. If the time is not known (e.g., the subject awakens from sleep with new symptoms), the last time the patient was observed to be neurologically intact must be considered to be the time of onset.
  4. Documented baseline NIHSS score of > 7 and < 17 prior to IV rt-PA administration. Subjects who transfer from other facilities after receiving IV rt-PA must have a documented NIHSS by a certified examiner prior to initiation of rt-PA treatment. Documentation of NIHSS score via telemedicine is acceptable if performed by a certified examiner. Subjects who improve prior to NTS procedure will still be treated, unless their NIHSS improves to 0.
  5. Full functional independence just prior to the present stroke episode as defined by the following criteria:

    • Estimated prestroke mRS score 0 or 1.
    • Ambulates independently, may need a cane or walker, but does not need the assistance of another person.
    • Absence of a medical/physical/mental condition that substantially limits the subject's ability to work, study, participate in leisure activities, or look after family at home
    • Completely independent, does not need supervision (may live with other individuals, but could live alone if necessary)
  6. Negative serum or urine pregnancy test in females of childbearing potential.
  7. Subject (or legally authorized representative) provides written Informed Consent in compliance with local regulations prior to enrollment into this study.
  8. The subject (and caregiver, if applicable) is willing to participate in this study for at least 90 days after the onset of stroke.-

Exclusion Criteria:

  1. Evidence on from a pre-tPA head CT of an intracranial, subdural, or subarachnoid hemorrhage or clinical presentation suggestive of subarachnoid hemorrhage even if the initial neuroimaging scan is normal.
  2. Clinical presentation consistent with a brainstem or cerebellar stroke
  3. A rapidly improving neurological status that in the opinion of the investigator will make the subject unsuitable for participation in this study or patient rapidly improves to NIHSS of 0 by start of NTS procedure.
  4. The subject had a seizure at stroke onset or within the 7 days prior to stroke onset.
  5. Sustained blood glucose > 300 mg/dl or < 60 mg/dl
  6. Subjects who, on repeated measurement, have a systolic blood pressure > 185, or a diastolic blood pressure > 110mmHg, post rt-PA administration, or it is the opinion of the investigator that aggressive treatment to reduce blood pressure post thrombolysis is required to keep pressure within these limits.
  7. Presumed and/or confirmed septic embolus.
  8. The subject has a history of CNS vascular wall disease (e.g. aneurysm, AVM).
  9. The subject has a history of CNS disease or damage (e.g. neoplasm or dementia) which may influence the subject's outcome assessment.
  10. The subject has a significant skin condition (i.e., hemangioma, scleroderma, psoriasis, rash, open wound or tattoo) on their scalp that is found to be directly below three or more TLT procedure sites.
  11. Planned or actual use of any intra-arterial thrombolytic medication or a clot retrieval device, or any diagnostic or therapeutic interventional neurovascular procedure, including mechanical recanalization, whether successful or unsuccessful, during this stroke episode.
  12. Subject previously participated in another investigational drug or device trial within the preceding four weeks.
  13. Subject is a female who is pregnant or lactating (within the previous 30 days),or who is of child-bearing potential unless she is surgically sterile or she and/or her partner are using a medically acceptable method of birth control.
  14. The subject has an implant of any kind in the head (i.e. clipped aneurysm, embolised AVM, implantable shunt - Hakim valve).
  15. Any use of light-activated drugs (photodynamic therapy) within 14 days prior to study enrollment.
  16. The subject participated in the NEST-1, NEST-2, or NEST-3 Study.
  17. The subject has any co-existing or terminal disease that may limit life expectancy or any medical condition (e.g. morbid obesity, substance abuse) that may, in the clinical judgment of the Investigator, independently influence the subject's outcome during the course of the study.
  18. The subject is otherwise determined, based on the opinion of the Investigator,to be an unsuitable candidate for enrollment in this study. -
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01220739

Locations
United States, California
Huntington Memorial Hospital
Pasadena, California, United States, 91105
UCSD Medical Center
San Diego, California, United States, 92093
Santa Barbara Cottage Hospital
Santa Barbara, California, United States, 93105
Santa Barbara Cottage Hospital
Santa Barbra, California, United States, , 93105
United States, Colorado
Swedish Medical Center
Englewood, Colorado, United States, 80113
United States, South Carolina
Palmetto Health Richland
Columbia, South Carolina, United States, 29203
United States, Washington
Providence Medical Research Center
Spokane, Washington, United States, 99204
Sponsors and Collaborators
University of California, San Diego
  More Information

Publications:
Responsible Party: Justin Zivin, Professor, Department of Neurosciences, University of California, San Diego
ClinicalTrials.gov Identifier: NCT01220739     History of Changes
Other Study ID Numbers: StELLAR
Study First Received: October 13, 2010
Last Updated: April 20, 2013
Health Authority: United States: Food and Drug Administration

Keywords provided by University of California, San Diego:
ischemic stroke
laser
tissue plasminogen activator
therapy

Additional relevant MeSH terms:
Ischemia
Stroke
Cerebral Infarction
Pathologic Processes
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
Brain Infarction
Brain Ischemia
Tissue Plasminogen Activator
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Cardiovascular Agents
Therapeutic Uses
Hematologic Agents

ClinicalTrials.gov processed this record on April 21, 2014