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Pragmatic Ischaemic Stroke Thrombectomy Evaluation (PISTE)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01745692
Recruitment Status : Terminated (IDMC decision - recommended on basis of results from other relevant clinical trials, there were not safety concerns)
First Posted : December 10, 2012
Last Update Posted : October 26, 2015
University of Glasgow
University of Edinburgh
Newcastle University
Information provided by (Responsible Party):
NHS Greater Glasgow and Clyde

Brief Summary:
Ischaemic strokes (those caused by blockage in an artery in the brain caused by a blood clot) can be treated with very early use of clot-busting (thrombolytic) drugs to attempt to restore the blood supply and limit the damage, resulting in an increased proportion of people making a recovery to independence after stroke. However, drug treatment only succeed in restoring blood flow in a minority of people with clots in the larger arteries (10-25% depending on the size of the blood vessel) and these people also have the most severe strokes and highest risk of death or dependence as a result of the stroke. Current best treatment is therefore least effective in the group with the most severe strokes. Devices that can be fed through the blood vessels to either remove or break up the blood clot in the brain vessels can open this type of large artery blockage. However, using these devices is a highly skilled procedure and it takes some time both to set up the necessary facilities (including anaesthetic, nurses and medical support) and to reach the blockage. The extra time that is required to use these devices may mean that brain tissue is already irreversibly damaged. If so, then an individual patient cannot benefit and indeed may be harmed by opening the artery. There are no completed clinical trials comparing the outcome in people treated with standard stroke treatment and those treated with devices. PISTE is a randomised, controlled trial to test whether additional mechanical thrombectomy device treatment improves functional outcome in patients with large artery occlusion who are given IV thrombolytic drug treatment as standard care.

Condition or disease Intervention/treatment Phase
Acute Ischaemic Stroke Device: Mechanical thrombectomy Drug: Intravenous rtPA Not Applicable

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 65 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomised Controlled Clinical Trial of Adjunctive Mechanical Thrombectomy Compared With Intravenous Thrombolysis in Patients With Acute Ischaemic Stroke Due to an Occluded Major Intracranial Vessel.
Study Start Date : December 2012
Actual Primary Completion Date : April 2015
Actual Study Completion Date : July 2015

Resource links provided by the National Library of Medicine

Drug Information available for: Alteplase

Arm Intervention/treatment
Active Comparator: Intravenous rtPA
IV alteplase (rtPA) 0.9mg/kg (10% of dose as bolus followed by 90% as infusion over 1 hour, to a maximum dose of 90mg total) given within 4.5 hours of onset of stroke symptoms
Drug: Intravenous rtPA
All patients receive IV alteplase
Other Name: alteplase

Experimental: Intravenous rtPA and Mechanical Thrombectomy
IV alteplase (rtPA) 0.9mg/kg (10% of dose as bolus followed by 90% as infusion over 1 hour, to a maximum dose of 90mg total) given within 4.5 hours of onset of stroke symptoms + additional mechanical thrombectomy procedure to commence within 90 minutes of start of IV rtPA infusion
Device: Mechanical thrombectomy
Drug: Intravenous rtPA
All patients receive IV alteplase
Other Name: alteplase

Primary Outcome Measures :
  1. modified Rankin Scale [ Time Frame: Day 90 +/-7 ]
    The proportion with favourable functional outcome defined as mRS 0-2 at 90 (+/-7) days based on the modified Rankin scale structured interview

Secondary Outcome Measures :
  1. modified Rankin Scale [ Time Frame: Day 90+/-7 ]
    Full neurological recovery (mRS 0-1 versus 2-6)

  2. Mortality [ Time Frame: Day 90 +/-7 ]
  3. modified Rankin Scale [ Time Frame: Day 90 +/-7 ]
    Change in distribution of mRS scores adjusted for baseline variables

  4. NIH Stroke Scale (NIHSS) [ Time Frame: 72 hours ]
    Early major neurological improvement of 8 or more points, or return to NIHSS total score of 0 or 1, at 72 hours (or discharge if earlier)

  5. Angiographic patency [ Time Frame: 22-36 hours ]
    Angiographic patency at 22-36 hours (Core lab assessed), using CTA or MRA

  6. Immediate recanalisation rate [ Time Frame: End of procedure ]
    Immediate (i.e. end of procedure) recanalisation rates in subjects undergoing interventional procedures (core lab assessed).

  7. Home Time [ Time Frame: Day 90 +/-7 ]
    Days spent at home between stroke and day 90

  8. Symptomatic intracranial haemorrhage [ Time Frame: 22-26h ]
    Symptomatic intracranial haemorrhage rates defined as local or remote parenchymal haemorrhage type 2 (PH2 or PHr2 ICH by ECASS 2 definition) on the 22-36 h post-treatment imaging scan, combined with a neurological deterioration of 4 points or more on the NIHSS from baseline, or from the lowest NIHSS value between baseline and 24 h, or leading to death (SITS-MOST definition)

  9. Intracranial haemorrhage [ Time Frame: 22-36 hours ]
    Any intracranial haemorrhage on 22-36h CT or MRI

  10. Significant extracranial bleeding [ Time Frame: Up to day 90 ]
    Extracranial bleeding, groin haematoma requiring evacuation / surgery or transfusion

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Clinical diagnosis of supratentorial acute ischaemic stroke
  • Male or nonpregnant female ≥18 years of age
  • Clinically significant neurological deficit and NIHSS score ≥6.
  • Eligible for IV rtPA according to standard guidelines and able to be commenced on IV treatment <4.5h after symptom onset.
  • Enrolment, randomisation and procedure commencement (groin puncture) possible within 90 minutes of the start of IV rtPA treatment (groin puncture maximum 5.5h after stroke onset).
  • Occlusion of the main middle cerebral artery (MCA) trunk, MCA bifurcation or intracranial internal carotid artery(carotidT, M1 or single proximal M2 branch) demonstrated on CTA, MRA, or DSA.
  • Interventional device delivery (guide catheter placed beyond aortic arch and angio obtained) can be achieved within 6 hours of onset of the stroke.
  • Consent of patient or representative.
  • Independent prior to the stroke (estimated mRS 02)
  • Expected to be able to be followed up at 3 months

Exclusion Criteria:

  • CT evidence of intracranial haemorrhage, or evidence of extensive established hypodensity on CT.
  • Clinical history suggestive of subarachnoid haemorrhage even if CT normal.
  • Known vascular access contraindications e.g. femoral bypass surgery, tight ipsilateral carotid stenosis, unsuitable proximal vascular anatomy likely to render endovascular catheterisation difficult or impossible.
  • Extracranial ICA occlusion or basilar artery occlusion
  • Alternative intracranial pathology potentially responsible for the new symptoms
  • Medical comorbidities which would preclude safe cerebral vessel catheterisation or which are expected to limit life expectancy to <3 months (eg severe cardiac, renal or hepatic failure, significant coagulopathy, metastatic malignancy)
  • Known allergy to radiological contrast

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 identifier (NCT number): NCT01745692

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United Kingdom
NHS Greater Glasgow and Clyde
Glasgow, United Kingdom, G51 4TF
Sponsors and Collaborators
NHS Greater Glasgow and Clyde
University of Glasgow
University of Edinburgh
Newcastle University
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Principal Investigator: Keith W Muir, MD, FRCP University of Glasgow
Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: NHS Greater Glasgow and Clyde Identifier: NCT01745692    
Other Study ID Numbers: GN11NE257
TSA 2011/06 ( Other Grant/Funding Number: The Stroke Association )
First Posted: December 10, 2012    Key Record Dates
Last Update Posted: October 26, 2015
Last Verified: October 2015
Additional relevant MeSH terms:
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Cerebral Infarction
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
Pathologic Processes
Brain Infarction
Brain Ischemia
Tissue Plasminogen Activator
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action