Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy (MR RESCUE)
The purpose of this study is to compare the effectiveness of treating acute ischemic stroke with mechanical embolectomy using the Merci Retriever or the Penumbra System within 8 hours of symptom onset to standard medical treatment, and to identify people who might benefit from mechanical embolectomy by the appearance of stroke on multimodal computerized tomography (CT) or magnetic resonance (MR) imaging.
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy|
- The Modified Rankin Scale Score [ Time Frame: at 90 days post-stroke ] [ Designated as safety issue: No ]
Scale name is provided (Modified Rankin Scale) which is a standard measure of functional neurologic outcome in stroke. The scale runs from 0-6, running from perfect health without symptoms to 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 affairs 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 attention, bedridden, incontinent.
- 6 - Dead.
- Symptomatic Hemorrhagic Transformation [ Time Frame: from baseline to day 7 ] [ Designated as safety issue: Yes ]
Symptomatic intracranial hemorrhage is defined as 4 point neurologic worsening on the National Institutes of Health Stroke Scale (NIHSS) score associated with parenchymal hematoma type 2 (PH-2*), remote intracerebral hemorrhage, subarachnoid hemorrhage, or intraventricular hemorrhage on imaging. The NIHSS is a scale measuring specific neurologic deficits caused by a stroke with scores ranging from 0 to 42, and higher scores indicating more severe neurologic deficits.
*from the modified European Cooperative Acute Stroke Study (ECASS) II criteria
- Day 90 Mortality [ Time Frame: at day 90 ] [ Designated as safety issue: No ]
|Study Start Date:||May 2004|
|Study Completion Date:||April 2012|
|Primary Completion Date:||April 2012 (Final data collection date for primary outcome measure)|
Active Comparator: 1 Mechanical Embolectomy
Participants will be randomized to receive mechanical embolectomy treatment either with the Merci Retriever or Penumbra System and standard medical care or treatment with standard medical care alone.
Device: Merci Retriever and Penumbra System
The MERCI (Mechanical Embolus Removal in Cerebral Ischemia) Retriever consists of a flexible, nickel titanium (nitinol) wire with a helical-shaped distal tip. The helical distal tip is covered with a platinum radiopaque coil, which facilitates fluoroscopic visualization. The body of the MERCI Retriever is covered with a hydrophilic coating that helps facilitate device placement. The MERCI Retriever is available in 6 configurations (Merci Retrievers X6, L5, L4, L6, V series, DAC).
The Penumbra System uses a reperfusion catheter in parallel with a separator component and an aspiration source to achieve separation of the thrombus and subsequent aspiration of the occlusion from the vessel. The system is available in different sizes according to the target vessels (041 Reperfusion Catheter/Separator pair for use in vessels larger than 3mm, notably the ICA and M1; 032 Reperfusion Catheter/Separator pair for use in vessels 2mm - 3mm, notably the M2).
No Intervention: 2
standard medical care
Stroke most commonly occurs when there is a blockage of blood flow to one of the arteries in the brain. The blockage is often caused by a clot. There is currently only one FDA-approved stroke treatment. However, only 2 percent of ischemic stroke patients receive this treatment because it must be given within 4.5 hours of the stroke onset. There is an overwhelming need for new treatments that extend the time window to treatment since most individuals with stroke arrive at the hospital after the 4.5-hour time window.
Two of the most promising new devices are the Merci Retriever, a tiny corkscrew device, and the Penumbra System, an aspiration device. Both are designed to remove clots from arteries and thereby restore blood flow to the brain.
The primary purpose of this study is to compare the effectiveness of treatment with the Merci Retriever or Penumbra System within 8 hours of symptom onset to standard medical treatment, and to identify people who might benefit from the devices by the appearance of the stroke on multimodal computerized tomography (CT) or magnetic resonance imaging (MRI). Previous testing has determined that the use of the Merci Retriever is successful in opening up blocked blood vessels in approximately ½ of the individuals in whom it is used, and the Penumbra System is successful in opening up blocked blood vessels in approximately 80% of the individuals in whom it is used.
A total of 120 participants from approximately 30 different medical centers will be enrolled into this study. Participants will be randomized to either receive treatment by mechanical embolectomy with the Merci Retriever or Penumbra System and standard medical care or treatment with standard medical care alone. Standard care for stroke patients may include intravenous fluid, careful regulation of blood pressure, blood-thinning medicine (such as heparin or warfarin), anti-platelet medicine (such as aspirin or clopidogrel), and rehabilitation therapies.
Participants undergoing the Merci Retriever or Penumbra System procedure will have a cerebral arteriogram with pictures taken with dye prior to the procedure to determine the location of the blockage, and following the procedure to determine if blood supply has been restored. The total mechanical embolectomy procedure with either device will take approximately 1 to 2 hours. Participants will have brief neurological exams several times during this time to monitor changes in their neurological condition.
Participants will have follow-up visits, including neurological exams, at 30 days and at 90 days.
This study is part of the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS), which allows researchers to enhance and initiate translational research that ultimately will benefit stroke patients by treating more patients in less than 2 hours, and finding ways to treat additional patients later.
Hide Study Locations
|United States, California|
|University of California at Los Angeles, UCLA Stroke Network, 924 Westwood Blvd #300|
|Los Angeles, California, United States, 90024|
|Cedars Sinai Medical Center 8700 Beverly Blvd., Los Angeles CA 90048|
|Los Angeles, California, United States, 90048|
|Kaiser Permanente Los Angeles Medical Center 4867 W Sunset Blvd., Los Angeles CA 90027|
|Los Angeles, California, United States, 90027|
|University of California at San Diego, UCSD Medical Center, 200 W. Arbor Drive, OPC, 3rd Floor Suite 3|
|San Diego, California, United States, 92103|
|Santa Monica-UCLA Medical Center, 1225 15th Street Santa Monica, CA 90404|
|Santa Monica, California, United States, 90404|
|United States, District of Columbia|
|Georgetown University, Georgetown University Hospital, Room GG012, Ground Floor Gorman, 3800 Reservoir Road, NW|
|Washington, District of Columbia, United States, 20007|
|Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010|
|Washington, District of Columbia, United States, 20010|
|United States, Florida|
|University of Miami 1400 NW 10th Street, 10th Floor, Miami FL 33136|
|Miami, Florida, United States, 33136|
|United States, Iowa|
|University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242|
|Iowa City, Iowa, United States, 52242|
|United States, Maryland|
|Suburban Hospital, 8600 Old Georgetown Road, Bethesda, MD 20814|
|Bethesda, Maryland, United States, 20814|
|United States, Massachusetts|
|Boston University, One Boston Medical Center Place, Department of Neurology, C329|
|Boston, Massachusetts, United States, 01228|
|Massachusetts General Hospital, 101 Huntington Ave Ste 300|
|Boston, Massachusetts, United States, 02199|
|United States, Missouri|
|St. Louis University Hospital, 3635 Vista Avenue at Grand Boulevard Saint Louis, MO|
|St. Louis, Missouri, United States, 63110|
|United States, New York|
|Columbia University, 710 W 168th St, NI 551, ,|
|New York, New York, United States, 10032|
|Cornell University, New York Presbyterian Hospital, Cornell Campus, 525 East 68th St, Box 141|
|New York, New York, United States, 10021|
|United States, Ohio|
|University of Cincinnati, Department of Neurology, University of Cincinnati Medical Center, 231 Albert Sabin Way, Medical Sciences Bldg, Rm 4015, PO Box 670525|
|Cincinnati, Ohio, United States, 45267|
|United States, Pennsylvania|
|University of Pittsburgh, PUHC-426, 200 Lothrop Street|
|Pittsburgh, Pennsylvania, United States, 15213|
|United States, South Carolina|
|Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29403|
|Charleston, South Carolina, United States, 29403|
|United States, Tennessee|
|Chattanooga Center for Neurologic Research|
|Chattanooga, Tennessee, United States|
|United States, Texas|
|University of Texas at Houston, University of Texas, Houston Stroke Program, Department of Neurology, 6431 Fannin Street, MSB 7044|
|Houston, Texas, United States, 77030|
|United States, West Virginia|
|West Virginia University 1 Medical Center, Morgantown WV 26506|
|Morgantown, West Virginia, United States, 26506|
|University of Calgary|
|Calgary, Alberta, Canada|
|Principal Investigator:||Chelsea S Kidwell, MD||Professor of Neurology, Georgetown University|
|Principal Investigator:||Reza Jahan, MD||Associate Professor of Radiology, UCLA Medical Center, Interventional Neuroradiology|