Minimally Invasive Surgery and rtPA for Intracerebral Hemorrhage Evacuation "MISTIE"

Completed

Phase 2 Results

Update History

19 Jun '15
Trial name was updated.
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Minimally Invasive Surgery and rtPA for Intracerebral Hemorrhage Evacuation
The Summary of Purpose was updated.
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The purpose of this trial is to determine the safety of using a combination of minimally invasive surgery and clot lysis with rt-PA to remove intracerebral hemorrhage (ICH). The ICES arm of the trial will determine the safety of endoscopic surgery to remove ICH. All MISTIE intention to treat subjects represent the hypothesized test group. The ICES cohort is to be analyzed separately.
Old
The purpose of this trial is to determine the safety of using a combination of minimally invasive surgery and clot lysis with rt-PA to remove intracerebral hemorrhage (ICH). The ICES arm of the trial will determine the safety of endoscopic surgery to remove ICH.
The description was updated.
New
The purpose of this trial is to determine the safety of using a combination of minimally invasive surgery and clot lysis with rt-PA to remove intracerebral hemorrhage (ICH). The procedure is to use image-based surgery (MRI or CT) to provide catheter access to ICH for the intervention, which is a one-time clot aspiration followed by instillation of rt-PA over 72 hours. The Intraoperative stereotactic CT-guided Endoscopic Surgery (ICES) arm of the trial will determine the safety, feasibility and effectiveness of endoscopic surgery to remove ICH. This tests the first step of the MISTIE surgical procedure with an endoscope, not a rigid cannula. We propose to test if these interventions facilitate more rapid and complete recovery of function and decreased mortality from this condition compared to conventional medical management without subjecting the patient to craniotomy. The specific objective of this trial is to test the safety of these interventions and assess their ability to remove blood clot from brain tissue.
Old
The purpose of this trial is to determine the safety of using a combination of minimally invasive surgery and clot lysis with rt-PA to remove intracerebral hemorrhage (ICH). The procedure is to use image-based surgery (MRI or CT) to provide catheter access to ICH for the intervention, which is a one-time clot aspiration followed by instillation of rt-PA over 72 hours. The Intraoperative stereotactic CT-guided Endoscopic Surgery (ICES) arm of the trial will determine the safety, feasibility and effectiveness of endoscopic surgery to remove ICH. We propose to test if these interventions facilitate more rapid and complete recovery of function and decreased mortality from this condition compared to conventional medical management without subjecting the patient to craniotomy. The specific objective of this trial is to test the safety of these interventions and assess their ability to remove blood clot from brain tissue.
21 Sep '12
The Summary of Purpose was updated.
New
The purpose of this trial is to determine the safety of using a combination of minimally invasive surgery and clot lysis with rt-PA to remove intracerebral hemorrhage (ICH). The ICES arm of the trial will determine the safety of endoscopic surgery to remove ICH.
Old
The purpose of this trial is to determine the safety of using a combination of minimally invasive surgery and clot lysis with rt-PA to remove intracerebral hemorrhage (ICH). The procedure is to use image-based surgery (MRI or CT) to provide catheter access to ICH for the intervention, which is a one-time clot aspiration followed by instillation of rt-PA over 72 hours. We propose to test if this intervention facilitates more rapid and complete recovery of function and decreased mortality from this condition compared to conventional medical management without subjecting the patient to craniotomy. The specific objective of this trial is to test the safety of this intervention and assess its ability to remove blood clot from brain tissue.
The description was updated.
New
The purpose of this trial is to determine the safety of using a combination of minimally invasive surgery and clot lysis with rt-PA to remove intracerebral hemorrhage (ICH). The procedure is to use image-based surgery (MRI or CT) to provide catheter access to ICH for the intervention, which is a one-time clot aspiration followed by instillation of rt-PA over 72 hours. The Intraoperative stereotactic CT-guided Endoscopic Surgery (ICES) arm of the trial will determine the safety, feasibility and effectiveness of endoscopic surgery to remove ICH. We propose to test if these interventions facilitate more rapid and complete recovery of function and decreased mortality from this condition compared to conventional medical management without subjecting the patient to craniotomy. The specific objective of this trial is to test the safety of these interventions and assess their ability to remove blood clot from brain tissue.
Old
None.
The eligibility criteria were updated.
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Inclusion Criteria: - Age 18-80 - GCS < 14 or a NIHSS > or equal to 6 - Spontaneous supratentorial ICH > or equal to 20cc - Symptoms less than 12 hours prior to diagnostic CT scan (an unknown time of symptom onset is exclusionary) - Intention to initiate surgery within 48 hours after diagnostic CT - First dose can be given within 54 hours after diagnostic CT (delays for post surgical stabilization of catheter bleeding or because of unanticipated surgical delay are acceptable with approved waiver from the coordinating center) (Does not apply to ICES Tier) - Six-hour clot size equal to the most previous clot size + 5 cc (as determined by an additional CT scan at least 6 hours after the initial stability scan (A*B*C)/2 method) - SBP < 200 mmHg sustained for 6 hours recorded closest to time of randomization - Historical Rankin score of 0 or 1 - Negative pregnancy test Exclusion Criteria: - Infratentorial hemorrhage (any involvement of the midbrain or lower brainstem as demonstrated by radiograph or complete third nerve palsy) - Patients with platelet count < 100,000, INR > 1.4, or an elevated PT or APTT (reversal of coumadin is permitted but the patient must not require coumadin during the acute hospitalization). Irreversible coagulopathy either due to medical condition or prior to randomization - Clotting disorders - Any concurrent serious illness that would interfere with the safety assessments including hepatic, renal, gastroenterologic, respiratory, cardiovascular, endocrinologic, immunologic, and hematologic disease - Patients with a mechanical valve - Patients with unstable mass or evolving intracranial compartment syndrome - Ruptured aneurysm, AVM, vascular anomaly - Greater than 80 years (higher incidence of amyloid) - Under 18 years of ag e (high incidence of occult vascular malformation) - Pregnant (positive pregnancy test) or lactating females (likelihood of altered coagulation function associated with the high estrogen/progesterone state) - Irreversibly impaired brainstem function (bilateral fixed, dilated pupils and extensor motor posturing), GCS less than or equal to 4 - Historical Rankin score greater than or equal to 2 - Intraventricular hemorrhage requiring external ventricular drainage - Internal bleeding, involving retroperitoneal sites, or the gastrointestinal, genitourinary, or respiratory tracts (Does not apply to ICES Tier) - Superficial or surface bleeding, observed mainly at vascular puncture and access sites (e.g., venous cutdowns, arterial punctures) or site of recent surgical intervention (Does not apply to ICES Tier) - Known risk for embolization, including history of left heart thrombus, mitral stenosis with atrial fibrillation, acute pericarditis, and subacute bacterial endocarditis (Does not apply to ICES Tier) - In the investigator's opinion, the patient is unstable and would benefit from a specific intervention rather than supportive care plus or minus MIS+rtPA - Prior enrollment in the study - Any other condition that the investigator believes would pose a significant hazard to the subject if the investigational therapy were initiated - Participation in another simultaneous trial of ICH treatment.
Old
Inclusion Criteria: - Age 18-80 - GCS < 14 or a NIHSS > or equal to 6 - Spontaneous supratentorial ICH > or equal to 20cc - Symptoms less than 12 hours prior to diagnostic CT scan (an unknown time of symptom onset is exclusionary) - Intention to initiate surgery within 48 hours after diagnostic CT - First dose can be given within 54 hours after diagnostic CT (delays for post surgical stabilization of catheter bleeding or because of unanticipated surgical delay are acceptable with approved waiver from the coordinating center) - Six-hour clot size equal to the most previous clot size + 5 cc (as determined by an additional CT scan at least 6 hours after the initial stability scan (A*B*C)/2 method) - SBP < 200 mmHg sustained for 6 hours recorded closest to time of randomization - Historical Rankin score of 0 or 1 - Negative pregnancy test Exclusion Criteria: - Infratentorial hemorrhage (any involvement of the midbrain or lower brainstem as demonstrated by radiograph or complete third nerve palsy) - Patients with platelet count < 100,000, INR > 1.4, or an elevated PT or APTT (reversal of coumadin is permitted but the patient must not require coumadin during the acute hospitalization). Irreversible coagulopathy either due to medical condition or prior to randomization - Clotting disorders - Any concurrent serious illness that would interfere with the safety assessments including hepatic, renal, gastroenterologic, respiratory, cardiovascular, endocrinologic, immunologic, and hematologic disease - Patients with a mechanical valve - Patients with unstable mass or evolving intracranial compartment syndrome - Ruptured aneurysm, AVM, vascular anomaly - Greater than 80 years (higher incidence of amyloid) - Under 18 years of ag e (high incidence of occult vascular malformation) - Pregnant (positive pregnancy test) or lactating females (likelihood of altered coagulation function associated with the high estrogen/progesterone state) - Irreversibly impaired brainstem function (bilateral fixed, dilated pupils and extensor motor posturing), GCS less than or equal to 4 - Historical Rankin score greater than or equal to 2 - Intraventricular hemorrhage requiring external ventricular drainage - Internal bleeding, involving retroperitoneal sites, or the gastrointestinal, genitourinary, or respiratory tracts - Superficial or surface bleeding, observed mainly at vascular puncture and access sites (e.g., venous cutdowns, arterial punctures) or site of recent surgical intervention - Known risk for embolization, including history of left heart thrombus, mitral stenosis with atrial fibrillation, acute pericarditis, and subacute bacterial endocarditis - In the investigator's opinion, the patient is unstable and would benefit from a specific intervention rather than supportive care plus or minus MIS+rtPA - Prior enrollment in the study - Any other condition that the investigator believes would pose a significant hazard to the subject if the investigational therapy were initiated - Participation in another simultaneous trial of ICH treatment.
A location was updated in Los Angeles.
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The overall status was removed for University of California Los Angeles.
A location was updated in Palo Alto.
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The overall status was removed for Stanford University.
A location was updated in Washington.
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The overall status was removed for Georgetown University.
A location was updated in Jacksonville.
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The overall status was removed for Mayo Clinic.
A location was updated in Chicago.
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The overall status was removed for Rush University.
A location was updated in Evanston.
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The overall status was removed for NorthShore University Health System.
A location was updated in Baltimore.
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The overall status was removed for Johns Hopkins University/Bayview Medical Center.
A location was updated in Baltimore.
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The overall status was removed for University of Maryland Medical Systems.
A location was updated in Edison.
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The overall status was removed for New Jersey Medical School.
A location was updated in New York.
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The overall status was removed for Mt. Sinai Medical Center.
A location was updated in Cincinnati.
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The overall status was removed for University of Cincinnati.
A location was updated in Cleveland.
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The overall status was removed for Case Western University.
A location was updated in Philadelphia.
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The overall status was removed for Temple University.
A location was updated in Philadelphia.
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The overall status was removed for Thomas Jefferson University.
A location was updated in Pittsburgh.
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The overall status was removed for University of Pittsburgh Medical Center.
A location was updated in Charleston.
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The overall status was removed for Medical University of South Carolina.
A location was updated in Houston.
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The overall status was removed for University of Texas, Houston.
A location was updated in San Antonio.
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The overall status was removed for University of Texas HSC, San Antonio.
A location was updated in Richmond.
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The overall status was removed for Virginia Commonwealth University.
A location was updated in Montreal.
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The overall status was removed for Montreal Neurological Institute at McGill University.
A location was updated in Heidelberg.
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The overall status was removed for University of Heidelberg.
A location was updated in Newcastle.
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The overall status was removed for Newcastle General Hospital.