Trial record 1 of 1 for:    NCT02258919
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Decompressive Hemicraniectomy in Intracerebral Hemorrhage (SWITCH)

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. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT02258919
Recruitment Status : Recruiting
First Posted : October 8, 2014
Last Update Posted : October 9, 2018
Information provided by (Responsible Party):
University Hospital Inselspital, Berne

Brief Summary:

Spontaneous intracerebral hemorrhage (ICH) remains a devastating disease with mortality rates up to 52% at 30 days. It is a major public health problem with an annual incidence of 10-30 per 100'000 population, accounting for 2 million (10-15%) of about 15 million strokes worldwide each year. The strategy of decompressive craniectomy (DC) is beneficial in patients with malignant middle cerebral artery (MCA) infarction. Based on the common pathophysiological mechanisms of these two conditions, this procedure is also frequently performed in patients with ICH, but is has not yet been investigated in a randomized trial.

The primary objective of this randomized controlled trial is to determine whether decompressive surgery and best medical treatment in patients with spontaneous ICH will improve outcome compared to best medical treatment only.

Secondary objectives are to analyze mortality, dependency and quality of life. Safety endpoints are to determine cause of any mortality and the rate of medical and surgical complications after DC compared with best medical treatment alone.

Condition or disease Intervention/treatment Phase
Cerebral Hemorrhage Procedure: Decompressive craniectomy (DC) and best medical treatment Procedure: Best medical treatment Not Applicable

  Show Detailed Description

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 300 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Swiss Trial of Decompressive Craniectomy Versus Best Medical Treatment of Spontaneous Supratentorial Intracerebral Hemorrhage (SWITCH): a Randomized Controlled Trial
Study Start Date : October 2014
Estimated Primary Completion Date : December 2019
Estimated Study Completion Date : June 2020

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Bleeding

Arm Intervention/treatment
Experimental: Decompressive craniectomy and best medical treatment
Decompressive craniectomy and best medical treatment
Procedure: Decompressive craniectomy (DC) and best medical treatment

Decompressive craniectomy:

All patients in the treatment group will receive DC of at least 12 cm according to institutional guidelines and a published surgical protocol.

Best medical treatment:

Best medical treatment is based on American Heart Association/American Stroke Association (AHA/ASA) and European Stroke Organisation (ESO) as published in the current protocol from 2010 and 2014 respectively.

Active Comparator: Best medical treatment
Best medical treatment
Procedure: Best medical treatment
Best medical treatment is based on American Heart Association/American Stroke Association (AHA/ASA) and European Stroke Organisation (ESO) as published in the current protocol from 2010 and 2014 respectively.

Primary Outcome Measures :
  1. Score in modified Rankin Scale (mRS) [ Time Frame: 6 months ]
    Assessed by telephone interview

Secondary Outcome Measures :
  1. Mortality [ Time Frame: 7 days, 30 days, 180 days, 12 months ]
  2. mRS score of 0-3 versus 4-6 [ Time Frame: 30 days, 180 days, 12 months ]
  3. Categorical shift in mRS score [ Time Frame: 180 days, 12 months ]
  4. Quality of life [ Time Frame: 180 days, 12 months ]
  5. Death and intracranial hemorrhage [ Time Frame: intraoperative ]

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Written informed consent of the patient or of patient's next of kin plus consent of an independent physician if patient is unable to consent before randomization
  • Acute stroke syndrome due to a spontaneous ICH, defined as the sudden occurrence of bleeding into the parenchyma of the basal ganglia and/or thalamus that may extend into the ventricles and into the cerebral lobes, and into the subarachnoid space, confirmed by clinical history and imaging
  • Age: ≥18 to ≤75 years
  • Glasgow coma scale (GCS) <14 and >7
  • Neurological deficit with a NIHSS score of ≥10 and ≤30
  • Able to be randomly assigned to surgical treatment within 66 hours after ictus
  • Surgery performed not later than 6 hours after randomization
  • Volume of hematoma ≥30 ml and ≤100 ml
  • Stable clot volume
  • International normalized ratio (INR) <1.5, thrombocytes >100 T/ml

Exclusion Criteria

  • ICH due to known or suspected structural abnormality in the brain (e.g., intracranial aneurysm, brain arteriovenous malformation, brain tumor) or brain trauma, or previous stroke thrombolysis
  • Cerebellar or brainstem hemorrhage
  • Exclusive lobar hemorrhage
  • Known advanced dementia or significant pre-stroke disability
  • Concomitant medical illness that would interfere with outcome assessment and follow-up
  • Randomization not possible within 66 hours after ictus
  • Pregnancy
  • Prior major brain surgery within <6 month or prior DC
  • Foreseeable difficulties in follow-up due to geographic reasons
  • Known definite contraindication for a surgical procedure
  • A very high likelihood that the patient will die within the next 24 hours on the basis of clinical and/or radiological criteria
  • Previous participation in this trial or in another ongoing investigational trial
  • Prior symptomatic ICH
  • ICH secondary to thrombolysis
  • Bilateral areactive pupils

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): NCT02258919

Contact: Emilie Seydoux, PhD +41 632 60 83
Contact: Patricia Plattner +41 632 39 70

Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck Recruiting
Innsbruck, Austria, 6020
Principal Investigator: Martin Ortler, Prof. Dr. med.         
Universitätsklinik für Neurochirurgie, Kepler Universitätsklinikum Linz Recruiting
Linz, Austria, 4020
Principal Investigator: Andreas Gruber, Prof. Dr. med.         
Department of Neurology, Helsinki University Central Hospital Recruiting
Helsinki, Finland, 00290
Principal Investigator: Daniel Strbian, Prof. Dr. med.         
Centre Hospitalier Universitaire de Caen Recruiting
Caen, France, 14033
Principal Investigator: Thomas Gaberel, Dr. med.         
Fondation Adolphe de Rothschild Recruiting
Paris, France, 75019
Contact: Mikael Mazighi, Prof. Dr. med.         
Klinik für Neurochirurgie, Universitätsklinikum Schleswig Holstein Recruiting
Lübeck, Schleswig Holstein, Germany, 23562
Principal Investigator: Jan Leppert, Dr. med.         
Klinik für Neurochirugie, Helios Klinikum Erfurt Recruiting
Erfurt, Thüringen, Germany, 99089
Principal Investigator: Rüdiger Gerlach, Prof. Dr. med.         
Klinik für Neurochirurgie Uniklinik RWTH Aachen Recruiting
Aachen, Germany, 52074
Principal Investigator: Gerrit Schubert, PD Dr. med.         
Department of Neurosurgery, Charité - Universitätsmedizin Berlin Recruiting
Berlin, Germany, 13353
Principal Investigator: Peter Vajkoczy, Prof. Dr. med.         
Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn Recruiting
Bonn, Germany, 53127
Principal Investigator: Erdem Güresir, PD Dr. med.         
Klinik für Neurochirurgie, Universitätsklinikum Düsseldorf Recruiting
Düsseldorf, Germany, 40225
Principal Investigator: Kerim Beseoglu, PD Dr. med.         
Neurologische Klinik, Universitätsklinikum Erlangen Recruiting
Erlangen, Germany, 91054
Principal Investigator: Hagen Huttner, Prof. Dr. med.         
Klinik für Neurochirurgie, Universitätsklinikum Essen (AöR) Recruiting
Essen, Germany, 45147
Principal Investigator: Ramazan Jabbarli, Dr. med.         
Zentrum der Neurologie und Neurochirurgie, Universitätsklinikum Frankfurt Recruiting
Frankfurt, Germany, 60590
Principal Investigator: Christian Senft, Prof. Dr. med         
Klinik für Neurochirurgie, Universitätsklinikum Freiburg Recruiting
Freiburg, Germany, 79106
Principal Investigator: Roland Rölz, Dr. med.         
Neurochirurgische Klinik, Universitätsklinikum Gießen und Marburg UKGM Recruiting
Gießen, Germany, 35392
Principal Investigator: Karsten Schöller, PD Dr. med.         
Klinik für Neurochirurgie, Universitätsmedizin Göttingen Recruiting
Göttingen, Germany, 37075
Principal Investigator: Dorothee Mielke, PD Dr. med.         
Klinik für Neurochirurgie, Klinikum Kassel Recruiting
Kassel, Germany, 34125
Principal Investigator: Wolfgang Deinsberger, Prof. Dr. med.         
Neurochirurgische Klinik, Universitätsmedizin Mainz Recruiting
Mainz, Germany, 55116
Principal Investigator: Florian Ringel, Prof. Dr. med         
Neurochirurgische Klinik, Universitätsklinikum Mannheim Recruiting
Mannheim, Germany, 68167
Principal Investigator: Daniel Hänggi, Prof. Dr. med.         
Dep. of Neurosurgery, Klinikum rechts der Isar der Technischen Universität München Recruiting
Munich, Germany, 81675
Principal Investigator: Maria Wostrack, PD Dr. med.         
Klinik für Allgemeine Neurologie, Universitätsklinikum Münster Recruiting
Münster, Germany, 48149
Principal Investigator: Jens Minnerup, Prof. Dr. med.         
Klinik für Neurochirurgie, Universitätsklinikum Würzburg Recruiting
Würzburg, Germany, 97080
Principal Investigator: Thomas Westermaier, PD Dr. med         
Academic Medical Center Amsterdam, Department of Neurology Recruiting
Amsterdam, Netherlands, 1105
Principal Investigator: Jonathan Coutinho, Dr. med.         
University Medical Center Utrecht, Department of Neurology, Department of Neurosurgery Recruiting
Utrecht, Netherlands, 3584
Principal Investigator: Jaap Kappelle, Prof. Dr. med.         
Servicio de Neurocirurgía Hospital de la Santa Creu i Sant Pau Recruiting
Barcelona, Spain, 08041
Principal Investigator: Fernando Muñoz Hernández, Dr. med.         
Servicio de Neurocirurgía Bellvitge Hospital Recruiting
Barcelona, Spain, 08907
Principal Investigator: Jose Luis Sanmillàn Blasco, Dr. med.         
Servicio de Neurología, Hospital Universitario La Paz Recruiting
Madrid, Spain, 28046
Principal Investigator: Exuperio Díez Tejedor, Prof. Dr. med.         
Servicios de Neurología, Neurocirugía y Cuidados Intensivos del Hospital Virgen del Rocío Recruiting
Sevilla, Spain, 41013
Principal Investigator: Javier De la Torre Laviana, Dr. med.         
Dep. of Neurology / Dep. of Neurosurgery, Bern University Hospital Recruiting
Bern, Switzerland, 3010
Contact: Emilie Seydoux, PhD    +41 632 60 83   
Principal Investigator: Urs Fischer, Prof. Dr. med.         
Dep. of Clinical Neuroscience, Service of Neurosurgery Recruiting
Geneva, Switzerland, 1211
Principal Investigator: Marco Corniola, Dr. med.         
Dep. of Neurosurgery, Kantonsspital Luzern Recruiting
Lucerne, Switzerland, 6000
Principal Investigator: Karl Kothbauer, PD Dr. med.         
Dep. Neurosurgery, Ospedale Regionale di Lugano Recruiting
Lugano, Switzerland, 6903
Principal Investigator: Pietro Scarone, Dr. med.         
Dep. of Neurosurgery, University Hospital Zürich Suspended
Zürich, Switzerland, 8091
Sponsors and Collaborators
University Hospital Inselspital, Berne
Study Director: Urs Fischer, Prof. Dr. med. Dep. of Neurology, Inselspital Bern
Study Chair: Jürgen Beck, Prof. Dr. med. Dep. of Neurosurgery, Inselspital Bern

Additional Information:
Responsible Party: University Hospital Inselspital, Berne Identifier: NCT02258919     History of Changes
Other Study ID Numbers: 163/14
32003B_150009 ( Other Grant/Funding Number: SNF )
First Posted: October 8, 2014    Key Record Dates
Last Update Posted: October 9, 2018
Last Verified: October 2018

Keywords provided by University Hospital Inselspital, Berne:
Intracerebral hemorrhage
Decompressive craniectomy
Randomized controlled trial
Acute stroke

Additional relevant MeSH terms:
Cerebral Hemorrhage
Pathologic Processes
Intracranial Hemorrhages
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases