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Clinical Registration Trial of Intracranial Stenting for Patients With Symptomatic Intracranial Artery Stenosis(CRTICAS)

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ClinicalTrials.gov Identifier: NCT01994161
Recruitment Status : Unknown
Verified October 2013 by Xuanwu Hospital, Beijing.
Recruitment status was:  Recruiting
First Posted : November 25, 2013
Last Update Posted : November 25, 2013
Sponsor:
Information provided by (Responsible Party):
Xuanwu Hospital, Beijing

Brief Summary:

This trial is an prospective, government-funded registration study that will observe the safety and effectiveness of intracranial stenting for preventing stroke during a mean follow-up of 12 months in patients with symptomatic stenosis of a major intracranial artery (MCA, carotid, vertebral, basilar). This trial will be launched by Xuanwu Hospital, Capital University of Medical Science, with 20 collaborators participating. Enrollment will begin in 2013, and it aims to have a sample size of 840 subjects in 2 years. The trial is scheduled to complete in 2015.

As we know, SAMMPRIS is flawed with defect in design, heterogeneity in experience and credentials of operators and high rate of complication; Whether the interventional therapy for symtomatic intracranial artery stenosis is effective or not remained resolved. This trial has been modified based on SAMMPRIS in order to acquire the data for China: Technique, experience, and credential of the operators are closely related with perioperative complications in PTAS. The investigators select 50 large-scale medical centers for participation on the basis of geographical distribution. All the participants are ranked as top in China. They have the most experienced surgeons or interventionist in China, and are fully qualified for this trial. This will guarantee the success and safety of technique, maintain the continuity of operator's experience, and make the complication rate as low as possible.


Condition or disease Intervention/treatment
Ischemic Stroke Procedure: intracranial stenting

Detailed Description:

Title:Clinical Registration Trial of Intracranial Stenting for Patients With Symptomatic Intracranial Artery Stenosis:A Prospective Multi-center, Registry Trial

Design of trial:

This trial is an prospective, government-funded registration study that will observe the safety and effectiveness of intracranial stenting for preventing stroke during a mean follow-up of 3 years in patients with symptomatic stenosis of a major intracranial artery (MCA, carotid, vertebral, basilar). This trial was launched by Xuanwu Hospital, Capital University of Medical Science, with 40 collaborators participating. Enrollment will begin in 2013, and it aims to have a sample size of 840 subjects in 2 years. The trial is scheduled to complete in 2015.

Details:

SAMMPRIS (Stenting vs. Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis) hasn't received the expected results; But, it does not mean that angioplasty with stent on intracranial treatment come to a full stop. On the contrary, a discrepancy on reported data between multi-centre RCT and most single center studies urges us for thorough investigation in future.

As we know, SAMMPRIS is flawed with defect in design, heterogeneity in experience and credentials of operators and high rate of complication; Some questions about SAMMPRIS have been raised, and remained unresolved.

This trial has been modified based on SAMMPRIS in order to acquire the data for China: Technique, experience, and credential of the operators are closely related with perioperative complications in PTAS. The investigators select 40 large-scale medical centers for participation on the basis of geographical distribution. All the participants are ranked as top in China. They have the most experienced surgeons or interventionist in China, and are fully qualified for this trial. This will guarantee the success and safety of technique, maintain the continuity of operator's experience, and make the complication rate as low as possible.

SAMMPRIS was stopped ahead of schedule due to the safety concern. More than half of the PTAS patients were lost for follow-up at 1 year, and the remaining were followed up with a mean duration less than 1 year. It leaves the question of long-time follow-up data open. Base on SAMMPRIS, the investigators' trial will conduct a systematic follow-up system. Upon recruitment, all the patients' neurological and imaging examination will be determined at baseline, 1 week, 1 month, 6 months , 12 months after surgery, respectively.

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Study Type : Observational [Patient Registry]
Estimated Enrollment : 840 participants
Observational Model: Cohort
Time Perspective: Prospective
Target Follow-Up Duration: 12 Months
Official Title: Clinical Registration Trial of Intracranial Stenting for Patients With Symptomatic Intracranial Artery Stenosis:A Prospective Multi-center, Registry Trial
Study Start Date : December 2012
Estimated Primary Completion Date : December 2014
Estimated Study Completion Date : December 2015

Group/Cohort Intervention/treatment
Intracranial stenting group
all the participants in this group will be performed with intracranial stenting
Procedure: intracranial stenting

all the participants in this group will be performed with intracranial stenting

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Primary Outcome Measures :
  1. Ischemic stroke, death or cardiovascular events [ Time Frame: 30 days ]
    The participants who suffer from Ischemic stroke, death or cardiovascular events after enrollment or any revascularization procedure of the qualifying lesion in the territory of the symptomatic intracranial artery


Secondary Outcome Measures :
  1. Any stroke, or death [ Time Frame: beyond 30 days through 6 months ]
    the number of participants who suffer from any stroke(minor or major, ischemic or bleeding) or death

  2. the number of participants who suffer from restenosis (>50%) related to intracranial stenting [ Time Frame: up to 12 months ]
    the number of participants who suffer from restenosis (>50%) related to intracranial stenting

  3. the changes from baseline in mRS, national institutes of health stroke scale (NIHSS) and Barthel Index [ Time Frame: at 7 days, 30 days, 6 months, 12 months, 24 months and 36 months ]
    the changes from baseline in mRS, national institutes of health stroke scale (NIHSS) and Barthel Index

  4. the number of participants who survives in all patients [ Time Frame: beyond 12 months to 36 months ]
    the number of participants who survives in all patients



Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   30 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
This trial is an prospective, government-funded registration study that will observe the safety and effectiveness of intracranial stenting for preventing stroke during a mean follow-up of 3 years in patients with symptomatic stenosis of a major intracranial artery (MCA, carotid, vertebral, basilar). This trial was launched by Xuanwu Hospital, Capital University of Medical Science, with 20 collaborators participating. Enrollment will begin in 2013, and it aims to have a sample size of 840 subjects in 2 years. The trial is scheduled to complete in 2015.
Criteria

Inclusion Criteria:

  • Symptomatic status: as evidenced by TIA or non-severe stroke within the past 12 months attributed to 70% to 99% stenosis of a major intracranial artery (carotid artery, MCA stem [M1], vertebral artery, or basilar artery).
  • Degree of stenosis: 70%-99%; (Stenosis must be confirmed by catheter angiography for enrollment in the trial,WASID method)
  • Age:30-80 years;
  • No fresh infarctions identified on MRI (indicated as high signals on DWI series) upon enrollment
  • No massive cerebral infarction (>1/2 MCA territory), intracranial hemorrhage, epidural or sub-dural hemorrhage, and intracranial brain tumor on CT or MRI scan
  • mRS scale score of <=2
  • Target vessel reference diameter must be measure d to be 2.00 mm to 4.50 mm; target area of stenosis is <=14 mm in length
  • Patient is willing and able to return for all follow-up visits required by the protocol
  • Patient understands the purpose and requirements of the study, can make him/herself understood, and has signed informed consent.

Exclusion Criteria:

  • Untoward reaction to anesthesia.
  • Any condition that precludes proper angiographic assessment or makes percutaneous arterial access unsafe.
  • Tandem extracranial or intracranial stenosis that is proximal or distal to the target intracranial lesion
  • Previous treatment of target lesion with a stent, angioplasty, or other mechanical device.
  • Any aneurysm proximal to or distal to stenotic intracranial artery. Intracranial tumor (except meningioma) or any intracranial vascular malformation
  • Computed tomographic or angiographic evidence of severe calcification at target lesion
  • Stroke of sufficient size (>5cm on CT or MRI) to place patient at risk of hemorrhagic conversion during the procedure.Hemorrhagic transformation of an ischemic stroke within the past 15 days.
  • Previous spontaneous intracerebral (parenchymal) or other intracranial (subarachnoid, subdural, or epidural) hemorrhage within 30 days
  • Untreated chronic subdural hematoma >5 mm in thickness
  • Intracranial arterial stenosis related to arterial dissection, moya-moya disease or any known vasculitic disease;
  • MI within previous 30 days
  • Any episode of paroxysmal atrial fibrillation within the past 6 months, or history of paroxysmal atrial fibrillation requiring chronic anticoagulation
  • Intolerance or allergic reaction to any of the study medications, including aspirin, clopidogrel, heparin, nitinol, and local or general anaesthesia History of life-threatening allergy to contrast dye. If not life-threatening and can be effectively pretreated, patient can be enrolled at physicians discretion
  • Recent GI bleed that would interfere with antiplatelet therapy. Active bleeding diathesis or coagulopathy; active peptic ulcer disease, major systemic hemorrhage within 30 days, active bleeding diathesis, platelets count <125,000, hematocrit <30, Hgb <10 g/dl, uncorrected INR >1.5, bleeding time >1 minute beyond upper limit normal, or heparin-associated thrombocytopenia that increases the risk of bleeding, uncontrolled severe hypertension (systolic BP>180 mm hg or diastolic BP>115 mm hg), severe liver impairment (AST or ALT >3 times normal, cirrhosis), creatinine >265.2μmol/l (unless on dialysis)
  • Major surgery (including open femoral, aortic, or carotid surgery) within previous 30 days or planned in the next 90 days after enrollment
  • Severe dementia or psychiatric problem that prevents the patient from following an outpatient program reliably
  • Pregnancy or of childbearing potential and unwilling to use contraception for the duration of this study

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01994161


Contacts
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Contact: Liqun Jiao, MD 86-10-83198899 ext 8836 jiaoliqun@gmail.com
Contact: Yabing Wang, MD 86-10-83198990 wangyabing@foxmail.com

Locations
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China
Department of neurosurgery, Xuanwu hospital Recruiting
Beijing, China, 100053
Contact: Liqun Jiao, MD    86-10-83198899 ext 8836    jiaoliqun@gmail.com   
Sponsors and Collaborators
Xuanwu Hospital, Beijing
Investigators
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Principal Investigator: Feng Ling, MD Xuanwu Hospital, Capital University of Medical Sciences, Beijing, China
Additional Information:

Publications of Results:

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Responsible Party: Xuanwu Hospital, Beijing
ClinicalTrials.gov Identifier: NCT01994161    
Other Study ID Numbers: XW125-S003
First Posted: November 25, 2013    Key Record Dates
Last Update Posted: November 25, 2013
Last Verified: October 2013
Keywords provided by Xuanwu Hospital, Beijing:
ischemic stroke
intracranial stenting
vascular risk factor management
Additional relevant MeSH terms:
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Stroke
Ischemia
Constriction, Pathologic
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
Pathologic Processes
Pathological Conditions, Anatomical