Interventional Management of Stroke (IMS) III Trial (IMSIII)

This study has been terminated.
(NINDS/NIH-DSMB recommended halting trial due to futility, no safety concerns.)
Sponsor:
Collaborators:
Medical University of South Carolina
University of Calgary
Information provided by (Responsible Party):
Joseph Broderick, University of Cincinnati
ClinicalTrials.gov Identifier:
NCT00359424
First received: July 31, 2006
Last updated: November 19, 2013
Last verified: November 2013
Results First Received: July 4, 2013  
Study Type: Interventional
Study Design: Allocation: Randomized;   Endpoint Classification: Safety/Efficacy Study;   Intervention Model: Parallel Assignment;   Masking: Open Label;   Primary Purpose: Treatment
Condition: Stroke
Interventions: Drug: IV rt-PA alone
Other: endovascular therapy

  Participant Flow
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Recruitment Details
Key information relevant to the recruitment process for the overall study, such as dates of the recruitment period and locations

A total of 656 participants underwent randomization

  • participants to endovascular therapy >> and 222 to intravenous t-PA alone) at 58 study >> centers between August 25, 2006, and April 17, >> 2012 in the United States (41 sites), Canada (7), >> Australia (4), and Europe (6)

Pre-Assignment Details
Significant events and approaches for the overall study following participant enrollment, but prior to group assignment
No text entered.

Reporting Groups
  Description
Endovascular Therapy Endovascular therapy (group two) received a lower dose (0.09mg per kg bolus and 0.54mg/kilogram infusion over 40 minutes, maximum dose 53.6mg) or after Amendment #5, a standard dose of IV rt-PA (.9mg/kg with 10% as a bolus and the remainder over one hour) and then underwent an angiogram test (cerebral angiography) right after the medicine was given to check for blood clots. If a clot was not seen, then no more treatment was given. If a clot was seen, the neurointerventionalist chose (based on the location and extent of the blood clot) a protocol approved endovascular treatment given directly in the brain artery that would be most effective in reopening the blocked artery.
IV Rt-PA Alone IV rt-PA alone (group one) received the standard dose (.9mg per kilogram with 10% as a bolus and the remainder as an infusion over 1 hour -maximum dose 90mg) of intravenous (IV) rt-PA alone.

Participant Flow:   Overall Study
    Endovascular Therapy     IV Rt-PA Alone  
STARTED     434     222  
90 Day Follow up     343     172  
180 Day Follow up     325     167  
270 Day Follow up     313     159  
COMPLETED     304     155  
NOT COMPLETED     130     67  
Death                 99                 58  
Lost to Follow-up                 19                 7  
Withdrawal by Subject                 10                 2  
follow up not conducted                 2                 0  



  Baseline Characteristics
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Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
A sample of 900 was calculated to provide an effect size of 10 percentage points assuming that 40% of the patients had a good outcome in the IV t-PA group, as noted in patients in the NINDS rt-PA Stroke Study who had age and baseline stroke severity similar to the eligibility criteria for the IMS3 trial. The trial was halted at 656 subjects.

Reporting Groups
  Description
Endovascular Therapy Group two will receive a lower dose or a standard dose of IV rt-PA and then undergo an angiogram test (cerebral angiography) right after the medicine is given to check for blood clots. If a clot is not seen then no more treatment will be given. If a clot is seen, the neurointerventionalist will then choose (based on the location and extent of the blood clot) a protocol approved endovascular treatment given directly in the brain artery that will be most effective in reopening the blocked artery.
IV Rt-PA Alone Group one will receive the standard dose of intravenous (IV) rt-PA alone given over an hour.
Total Total of all reporting groups

Baseline Measures
    Endovascular Therapy     IV Rt-PA Alone     Total  
Number of Participants  
[units: participants]
  434     222     656  
Age  
[units: years]
Median ( Full Range )
  69  
  ( 23 to 89 )  
  68  
  ( 23 to 84 )  
  69  
  ( 23 to 89 )  
Gender  
[units: participants]
     
Female     216     100     316  
Male     218     122     340  
NIHSS Score [1]
[units: Score on a scale]
Median ( Full Range )
  17  
  ( 7 to 40 )  
  16  
  ( 8 to 30 )  
  17  
  ( 7 to 40 )  
Time from stroke onset to initiation of IV rt-PA [2]
[units: minutes]
Mean ± Standard Deviation
  122.4  ± 33.7     121.2  ± 33.8     122.0  ± 33.7  
NIHSS Score Strata  
[units: participants]
     
NIHSS Score <20     302     150     452  
NIHSS Score > = 20     132     72     204  
[1]

The National Institutes of Health Stroke Scale (NIHSS), a serial measure of neurologic deficit, is a 42-point scale that >> quantifies neurologic deficits in 11 categories, with 0 indicating normal function without neurologic deficit and higher

>> scores indicating greater severity of deficit.

[2] Time from stroke onset to initiation of intravenous (IV) rt-PA in minutes.



  Outcome Measures
  Show All Outcome Measures

1.  Primary:   Modified Rankin Scale (mRS) Score Dichotomized to 0-2 Versus Greater Than 2.   [ Time Frame: at 90 days post randomization ]

2.  Primary:   Death Due to Any Cause   [ Time Frame: within 90 days post randomization ]

3.  Primary:   Symptomatic Intracranial Hemorrhage   [ Time Frame: within the first 30 hours post IV rt-PA ]

4.  Secondary:   Incidence of Parenchymal Type II (PH2) Hematomas   [ Time Frame: within 30 hours post IV rt-PA ]
  Hide Outcome Measure 4

Measure Type Secondary
Measure Title Incidence of Parenchymal Type II (PH2) Hematomas
Measure Description a dense intracerebral hematoma involving more than 30% of the infarcted area with substantial space-occupying effect or any hemorrhagic area outside the infarcted area, determined via central read of the submitted CT scans.
Time Frame within 30 hours post IV rt-PA  
Safety Issue Yes  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
Subjects were excluded if a post-baseline CT scan was not obtained within 30 hours of randomization (i.e., participants who died, had care withdrawn at the request of the family, or underwent imaging after the 30-hour window).

Reporting Groups
  Description
Endovascular Therapy Group two will receive a lower dose or a standard dose of IV rt-PA and then undergo an angiogram test (cerebral angiography) right after the medicine is given to check for blood clots. If a clot is not seen then no more treatment will be given. If a clot is seen, the neurointerventionalist will then choose (based on the location and extent of the blood clot) a protocol approved endovascular treatment given directly in the brain artery that will be most effective in reopening the blocked artery.
IV Rt-PA Alone Group one will receive the standard dose of intravenous (IV) rt-PA alone given over an hour.

Measured Values
    Endovascular Therapy     IV Rt-PA Alone  
Number of Participants Analyzed  
[units: participants]
  417     207  
Incidence of Parenchymal Type II (PH2) Hematomas  
[units: participants]
  25     13  

No statistical analysis provided for Incidence of Parenchymal Type II (PH2) Hematomas



5.  Secondary:   Asymptomatic Intracranial Hemorrhage   [ Time Frame: within 30 hours post IV rt-PA ]

6.  Secondary:   National Institutes of Health Stroke Scale Score (NIHSS) >> Dichotomized 0-1 Versus 2 or Greater.   [ Time Frame: at 24 hours post randomization ]

7.  Secondary:   National Institutes of Health Stroke Scale Score (NIHSS) Dichotomized 0-1 Versus 2 or Greater.   [ Time Frame: at 90 days post randomization ]

8.  Secondary:   Barthel Index (BI) Dichotomized 0-90 Versus 95-100   [ Time Frame: at 90 days post randomization ]

9.  Secondary:   Trail Making Test Part A Time   [ Time Frame: 90 days post randomization ]

10.  Secondary:   Trail Making Test Part B Time   [ Time Frame: at 90 days post randomization ]

11.  Secondary:   Modified Rankin Scale (mRS) Score Dichotomized to 0-2 Versus Greater Than 2   [ Time Frame: at 180 days ]

12.  Secondary:   Modified Rankin Scale (mRS) Score Dichotomized to 0-2 Versus Greater Than 2   [ Time Frame: 270 days ]

13.  Secondary:   Modified Rankin Scale (mRS) Score Dichotomized to 0-2 Versus Greater Than 2   [ Time Frame: 360 days post randomization ]


  Serious Adverse Events


  Other Adverse Events


  Limitations and Caveats
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Limitations of the study, such as early termination leading to small numbers of participants analyzed and technical problems with measurement leading to unreliable or uninterpretable data
The IMS III trial was stopped early because of futility, according to the prespecified rules. A limitation of our trial is that it did not compare the efficacy of the new stent retrievers with that of intravenous t-PA alone.


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