Working...
ClinicalTrials.gov
ClinicalTrials.gov Menu
Trial record 1 of 1 for:    MISTIE III Minimally invasive surgery plus rt-PA in the treatment of intracerebral hemorrhage
Previous Study | Return to List | Next Study

Minimally Invasive Surgery Plus Rt-PA for ICH Evacuation Phase III (MISTIE-III)

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.
ClinicalTrials.gov Identifier: NCT01827046
Recruitment Status : Completed
First Posted : April 9, 2013
Last Update Posted : December 11, 2018
Sponsor:
Collaborators:
National Institute of Neurological Disorders and Stroke (NINDS)
Genentech, Inc.
Emissary International LLC
Information provided by (Responsible Party):
Johns Hopkins University

Brief Summary:
A phase III, randomized, case-controlled, open-label, 500-subject clinical trial of minimally invasive surgery plus rt-PA in the treatment of intracerebral hemorrhage (ICH).

Condition or disease Intervention/treatment Phase
Intracerebral Hemorrhage Drug: rt-PA Phase 3

Detailed Description:

Primary Objectives:

Efficacy: Demonstrate that minimally invasive surgery (MIS) plus recombinant tissue plasminogen activator (rt-PA) for three days improves functional outcome by a 12% increase in the modified Rankin Scale (mRS) score 0-3 compared to medically treated subjects assessed at 365 days.

Secondary Objective:

Demonstrate that the end of treatment volume and percent of ICH reduction from MIS+rt-PA is related to improved functional outcome, as compared to medically treated subjects.

Safety:

Demonstrate that early use of MIS+rt-PA for three days is safe for the treatment of ICH relative to rates of mortality, rebleeding, and infection in the medically treated subject at 30 days.


Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 506 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Minimally Invasive Surgery Plus Rt-PA for ICH Evacuation Phase III
Actual Study Start Date : December 30, 2013
Actual Primary Completion Date : September 2018
Actual Study Completion Date : September 2018

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Bleeding
Drug Information available for: Alteplase

Arm Intervention/treatment
Experimental: MIS plus rt-PA management
Subjects randomized to the MIS plus rt-PA management arm will undergo minimally invasive surgery followed by up to 9 doses of 1.0 mg of rt-PA (Activase/Alteplase/CathFlo) for intracerebral hemorrhage clot resolution.
Drug: rt-PA
Up to 9 doses of 1.0 mg of rt-PA will be administered through the catheter that was placed directly into the intracerebral hemorrhage using minimally invasive surgery.
Other Names:
  • Activase
  • Alteplase
  • CathFlo

No Intervention: Medical management
Subjects randomized to medical management will receive the standard medical therapies for the treatment of intracerebral hemorrhage, which includes ICU care only and no planned surgical intervention.



Primary Outcome Measures :
  1. Dichotomized, adjudicated modified Rankin Scale score 0-3 vs. 4-6 at 365 days post ictus (adjusted) [ Time Frame: Day 365 ]
    Dichotomized, adjudicated, cross-sectional modified Rankin Scale (mRS) score 0-3 vs. 4-6 at 365 days post-ictus, adjusting for baseline (pre-randomization) variables used in covariate adaptive randomization as well as the clinically established severity variables IVH size and ICH location (lobar or deep). The mRS is a commonly used scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. It is scored from 0 (perfect health without symptoms) to 6 (death).


Secondary Outcome Measures :
  1. Dichotomized extended Glasgow Outcome Scale (eGOS) score UGR-US vs. LS-Death at 365 days post ictus (adjusted) [ Time Frame: Day 365 ]
    Dichotomized, cross-sectional extended Glasgow Outcome Scale (eGOS) score upper good recovery (UGR) through upper severe disability (US) vs. lower severe disability (LS) through death at 365 days post ictus, adjusting for baseline (pre-randomization) variables used in covariate adaptive randomization as well as the clinically established severity variables IVH size and ICH location (lobar or deep). The eGOS is a commonly used scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. It is scored from UGR (perfect health without symptoms) to death.

  2. All cause mortality longitudinally from ictus to 365 days (adjusted) [ Time Frame: Day 365 ]
    By group comparison of mortality from ictus to 365 days adjusted for baseline severity.

  3. Clot removal (amount of residual blood) [ Time Frame: Day 365 ]
    Relationship between clot removal as an AUC clot-assessment that estimates the time-averaged clot volume and percent clot removed from ictus to end of treatment (EOT; i.e., 24 hours after last dose) as AUC clot exposure and functional outcome (proportion 0-3 Modified Rankin Scale (mRS)).

  4. Patient disposition: Home days over 365 days time from ictus. [ Time Frame: Day 365 ]
    By group comparison of total days at home during the 365 days post ictus.

  5. Patient disposition: Patient location at 365 days post ictus (i.e., good vs. bad location) (adjusted) [ Time Frame: Day 365 ]
    By group comparison of residential location at day 365 post ictus adjusted for baseline severity.

  6. Dichotomized, adjudicated, cross-sectional modified Rankin Scale (mRS) score 0-3 vs. 4-6 180 days post ictus (adjusted) [ Time Frame: Day 180 ]
    Dichotomized, adjudicated, cross-sectional modified Rankin Scale (mRS) score 0-3 vs. 4-6 at 180 days post-ictus, adjusting for baseline (pre-randomization) variables used in covariate adaptive randomization as well as the clinically established severity variables IVH size and ICH location (lobar or deep). The mRS is a commonly used scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. It is scored from 0 (perfect health without symptoms) to 6 (death).

  7. Dichotomized extended Glasgow Outcome Scale (eGOS) score UGR-US vs. LS-Death at 180 days post ictus (adjusted) [ Time Frame: Day 180 ]
    Dichotomized, cross-sectional extended Glasgow Outcome Scale (eGOS) score upper good recovery (UGR) through upper severe disability (US) vs. lower severe disability (LS) through death at 180 days post ictus, adjusting for baseline (pre-randomization) variables used in covariate adaptive randomization as well as the clinically established severity variables IVH size and ICH location (lobar or deep). The eGOS is a commonly used scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. It is scored from UGR (perfect health without symptoms) to death.

  8. Type and intensity of ICU management: ICU days [ Time Frame: Day 365 ]
    By group comparison of total number of days in the intensive care unit (ICU) during the acute hospitalization.

  9. Type and intensity of ICU management: Hospital days [ Time Frame: Day 365 ]
    By group comparison of total number of days in the hospital during the acute hospitalization.

  10. EQ-VAS [ Time Frame: Day 365 ]
    By group comparison of EQ-VAS at day 365 post ictus. The EuroQol Visual Analogue Scale (EQ-VAS) is a self-reported measure of health status. It is a marked scale where subjects draw a line to indicate their health, with end points of 0 (the worst health you can imagine) and 100 (the best health you can imagine).

  11. EQ-5D [ Time Frame: Day 365 ]
    By group comparison of EQ-5D at day 365 post ictus. The EuroQol 5 Dimensional Scale (Eq-5D) is a self-reported measure of health status. It is arranged to assess domains related to mobility, self-care, usual activities, pain/discomfort, and anxiety/depression.


Other Outcome Measures:
  1. Mortality and safety events at 30 days post-randomization: First-week (operative) mortality [ Time Frame: Day 7 ]
    By group comparison of mortality within the first 7 days post randomization.

  2. Mortality and safety events at 30 days post-randomization: All cause mortality [ Time Frame: Day 30 ]
    By group comparison of mortality from all causes within the first 30 days post randomization.

  3. Mortality and safety events at 30 days post-randomization: Adjudicated symptomatic brain bleeding [ Time Frame: Day 30 ]
    By group comparison of the percentage of subjects experiencing one or more adjudicated symptomatic brain bleeding events within the first 30 days post randomization.

  4. Mortality and safety events at 30 days post-randomization: Adjudicated bacterial brain Infection [ Time Frame: Day 30 ]
    By group comparison of the percentage of subjects experiencing one or more adjudicated brain bacterial infection events within the first 30 days post randomization.

  5. Mortality and safety events at 30 days post-randomization: Total serious adverse events (SAE) at 30 days [ Time Frame: Day 30 ]
    By group comparison of the total number of adjudicated serious adverse events that occurred within the first 30 days post randomization.

  6. Mortality and safety events at 30 days post-randomization: Summary of AE and SAE by MedDRA code and grouped by organ system [ Time Frame: Day 30 ]
    By group comparison of the total number of subjects experiencing one or more adjudicated adverse events (AE) and serious adverse events (SAE) across all coded organ systems that occurred within the first 30 days post randomization.



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.


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

Inclusion Criteria:

  • Spontaneous supratentorial ICH ≥ 30 mL diagnosed using radiographic imaging (computerized tomography (CT), computerized tomography angiography (CTA), etc.), with a Glasgow Coma Scale (GCS) ≤ 14 or a NIHSS ≥ 6.
  • Stability CT scan done at least 6 hours after diagnostic CT showing clot stability (growth < 5 mL as measured by ABC/2 method).
  • Symptoms less than 24 hours prior to diagnostic CT (dCT) scan (an unknown time of onset is exclusionary).
  • Ability to randomize between 12 and 72 hours after dCT.
  • Systolic Blood Pressure (SBP) < 180 mmHg sustained for six hours recorded closest to the time of randomization.
  • Historical Rankin score of 0 or 1.
  • Age ≥ 18 and older.

Exclusion Criteria:

  • Infratentorial hemorrhage.
  • Intraventricular hemorrhage (IVH) requiring treatment for IVH-related (casting) mass effect or shift due to trapped ventricle. External ventricular drain (EVD) to treat intracranial pressure (ICP) is allowed.
  • Thalamic bleeds with apparent midbrain extension with third nerve palsy or dilated and non-reactive pupils. Other (supranuclear) gaze abnormalities are not exclusions. Note: Patients with a posterior fossa ICH or cerebellar hematomas are ineligible.
  • Irreversible impaired brain stem function (bilateral fixed, dilated pupils and extensor motor posturing), GCS ≤ 4.
  • Ruptured aneurysm, arteriovenous malformation (AVM), vascular anomaly, Moyamoya disease, hemorrhagic conversion of an ischemic infarct, recurrence of a recent (< 1 year) hemorrhage diagnosed with radiographic imaging.
  • Patients with unstable mass or evolving intracranial compartment syndrome.
  • Platelet count < 100,000; international normalized ratio (INR) > 1.4.
  • Any irreversible coagulopathy or known clotting disorder.
  • Inability to sustain INR ≤ 1.4 using short- and long-active procoagulants (such as but not limited to NovoSeven, Fresh Frozen Plasma (FFP), and/or vitamin K).
  • Subjects requiring long-term anti-coagulation are excluded. Reversal of anti-coagulation is permitted for medically stable patients who can realistically tolerate the short term risk of reversal. Patient must not require Coumadin (anticoagulation) during the first 30 days, and normalized coagulation parameters must be demonstrated, monitored closely and maintained during the period of brain instrumentation.
  • Use of Dabigatran, Apixaban, and/or Rivaroxaban (or a similar medication from the similar medication class) prior to symptom onset.
  • 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, etc.) or site of recent surgical intervention.
  • Positive urine or serum pregnancy test in pre-menopausal female subjects without a documented history of surgical sterilization.
  • Allergy/sensitivity to rt-PA.
  • Prior enrollment in the study.
  • Participation in a concurrent interventional medical investigation or clinical trial. Patients in observational, natural history, and/or epidemiological studies not involving an intervention are eligible.
  • Not expected to survive to the day 365 visit due to co-morbidities and/or are do not resuscitate (DNR)/ do not intubate (DNI) status prior to randomization.
  • 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 heart valve. Presence of bio-prosthetic valve(s) is permitted.
  • Known risk for embolization, including history of left heart thrombus, mitral stenosis with atrial fibrillation, acute pericarditis, or subacute bacterial endocarditis.
  • Any other condition that the investigator believes would pose a significant hazard to the subject if the investigational therapy were initiated.
  • Active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements.
  • In the investigator's opinion, the patient is unstable and would benefit from a specific intervention rather than supportive care plus or minus MIS+rt-PA removal of the ICH.
  • Inability or unwillingness of subject or legal guardian/representative to give written informed consent.

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): NCT01827046


  Show 84 Study Locations
Sponsors and Collaborators
Johns Hopkins University
National Institute of Neurological Disorders and Stroke (NINDS)
Genentech, Inc.
Emissary International LLC
Investigators
Layout table for investigator information
Study Chair: Daniel F. Hanley, MD Johns Hopkins University
Principal Investigator: Mario Zuccarello, MD University of Cincinnati
Principal Investigator: Issam Awad, MD University of Chicago
  Study Documents (Full-Text)

Documents provided by Johns Hopkins University:
Statistical Analysis Plan  [PDF] July 25, 2018


Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Layout table for additonal information
Responsible Party: Johns Hopkins University
ClinicalTrials.gov Identifier: NCT01827046     History of Changes
Other Study ID Numbers: NA_00080619
U01NS080824 ( U.S. NIH Grant/Contract )
ICH02 ( Other Identifier: Other )
First Posted: April 9, 2013    Key Record Dates
Last Update Posted: December 11, 2018
Last Verified: December 2018

Layout table for additional information
Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Johns Hopkins University:
intracerebral hemorrhage
ICH
brain hemorrhage
minimally invasive surgery
rt-PA

Additional relevant MeSH terms:
Layout table for MeSH terms
Hemorrhage
Cerebral Hemorrhage
Intracranial Hemorrhages
Tissue Plasminogen Activator
Pathologic Processes
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
Fibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action