Combined Use of Contact Aspiration and the Stent Retriever Technique Versus Stent Retriever Alone for Recanalisation in Acute Cerebral Infarction (ASTER2)
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|ClinicalTrials.gov Identifier: NCT03290885|
Recruitment Status : Active, not recruiting
First Posted : September 25, 2017
Last Update Posted : August 24, 2018
Mechanical thrombectomy (MT) with a stent retriever (SR) device is now the standard intervention in ischemic stroke with large vessel occlusion. Favorable outcome is strongly associated with the successful reperfusion status. New device of MT such as contact aspiration seems promising to increase reperfusion status and clinical outcome.
The main hypothesis is to show the superiority of combining the use of contact aspiration with a stent retriever compared to a stent retriever alone in treatment of acute stroke due to proximal arterial occlusion.
The primary endpoint is the rate of perfect reperfusion score at the end of the endovascular procedure.
|Condition or disease||Intervention/treatment||Phase|
|Acute Ischemic Stroke||Combination Product: Combined contact aspiration/Stent Retriever Technique Device: Stent retriever technique||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||408 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Single (Outcomes Assessor)|
|Official Title:||Combined Use of Contact Aspiration and the Stent Retriever Technique Versus Stent Retriever Alone for Recanalisation in Acute Cerebral Infarction: the Randomized ASTER2 Study|
|Actual Study Start Date :||October 16, 2017|
|Estimated Primary Completion Date :||February 28, 2020|
|Estimated Study Completion Date :||February 28, 2020|
Experimental: Combined use of contact aspiration and stent retriever
Combined use of contact aspiration and stent retriever mechanical thrombectomy for recanalization
Combination Product: Combined contact aspiration/Stent Retriever Technique
Combined contact aspiration/SR is performed using a balloon-guide catheter (BGC). A 0.021 to 0.027 inch inner lumen microcatheter with a 0.014 to 0.016 inch micro-wire inside is introduced into a large-bore aspiration catheter and this construct is introduced into BGC. The BGC is placed into the origin of the cervical internal carotid artery (ICA). The catheter is advanced past the thrombus over the micro-wire to allow the SR deployment. The SR is deployed across the occlusion. Then the large bore distal access catheter is advanced to contact the proximal edge of the SR. The aspiration pump is connected to the large bore distal access catheter. After at least 90 sec, the SR and the large bore distal access catheter are pulled out as an unit from the BGC and the patient. Manual aspiration is also be applied to the BGC during the pull-out manoeuver which is performed after the temporary inflation of the balloon at the tip of the BGC to ensure flow arrest into the carotid
Active Comparator: Stent retriever mechanical thrombectomy alone
Stent retriever mechanical thrombectomy alone for recanalisation
Device: Stent retriever technique
The technique used should be in accordance with the device instruction for use. A large bore balloon guide catheter has to be placed into the cervical ICA.
A suitable delivery microcatheter is navigated over a micro-wire into the occluded major coronary artery MCA and across the occlusion. A control superselective angiogram may be used to document the extent of occlusion and thrombus. The stent retriever device is then deployed across the occlusion.
After at least 90 seconds, removal should occur with proximal occlusion by inflation of the balloon guide catheter.
- Perfect reperfusion rate [ Time Frame: 24 hours ]Perfect reperfusion rate at the end of angiography defined as a Thrombolysis In Cerebral Infarction (TICI) 2c/3 score (TICI score = Thrombolysis In Cerebral Infarction)
- Rate of successful reperfusion [ Time Frame: 24 hours ]Rate of successful reperfusion (mTICI 2b/2c/3), and complete reperfusion (mTICI3) at end of endovascular procedure
- Rate of perfect (mTICI 2c/3), successful reperfusion (mTICI 2b/2c/3), and complete reperfusion (mTICI3) after the frontline strategy [ Time Frame: 24 hours ]
- Time from groin puncture to achieve TICI 2c or better revascularization [ Time Frame: 24 hours ]Time from groin puncture to achieve TICI 2c or better revascularization
- Time between groin puncture to clot contact and clot contact to maximum reperfusion [ Time Frame: 24 hours ]Time between groin puncture to clot contact and clot contact to maximum reperfusion
- Modified Rankin scale (mRs) [ Time Frame: 90 days ]Global disability assessed by overall distribution of mRs at 90-days
- Rate of favorable functional independence [ Time Frame: 90 days ]Rate of favorable functional independence defined as a mRS 0-2 at 90 days
- Rate of excellent functional outcome [ Time Frame: 90 days ]Rate of excellent functional outcome defined as a Modified Rankin scale (mRS) 0-1 at 90 days
- NIHSS score [ Time Frame: 24 hours ]Change in NIHSS from baseline to 24 hours (delta NIHSS)
- Rate of symptomatic and asymptomatic intracerebral hemorrhage [ Time Frame: 24 hours ]Rate of symptomatic and asymptomatic intracerebral hemorrhage at MRI 24h after thrombectomy (according the third European Cooperative Acute Stroke Study (ECASS3) classification) (independent core lab adjudication).
- Rate of parenchymal hematoma [ Time Frame: 90 days ]
- Rate of all-cause mortality [ Time Frame: 90 days ]
- Rate of periprocedural complications [ Time Frame: 90 days ]- Rate of periprocedural complications: Occurrence of emboli to new territory (ENT), vasospasm, dissection, or perforation.
- Average cost per patient [ Time Frame: 90 days ]Average cost per patient with complete recanalization
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): NCT03290885
|Fondation Ophtalmologique Rotschild|
|Paris, France, 75019|
|Suresnes, France, 92150|
|Principal Investigator:||Bertrand Lapergue, MD||Hôpital Foch|
|Study Chair:||Michel Pottin, MD||Fondation Ophtalmologique de Rothschild|