The TESLA Trial: Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke (TESLA)
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|ClinicalTrials.gov Identifier: NCT03805308|
Recruitment Status : Active, not recruiting
First Posted : January 15, 2019
Last Update Posted : December 14, 2022
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|Condition or disease||Intervention/treatment||Phase|
|Ischemic Stroke||Procedure: Intra-arterial Therapy||Not Applicable|
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||300 participants|
|Intervention Model:||Parallel Assignment|
|Intervention Model Description:||TESLA is a pragmatic, phase III, prospective, randomized, open-label, blinded endpoint, multicenter trial. Patients with moderate-large infarcts will be assigned to either best medical management alone (including intravenous recombinant tissue-type plasminogen activator (IV rtPA)) or intra-arterial treatment (IAT) with mechanical thrombectomy added to best medical management. Mechanical thrombectomy will be performed with FDA-approved thrombectomy devices in accordance with the instructions for use (IFU). Patients will be enrolled at up to 25 centers over an anticipated three-year period, with an additional year for trial closeout.|
|Masking:||Single (Outcomes Assessor)|
The patient and the treating physician will be aware of the treatment assignment. Assessment of outcome on NIHSS and mRS will be performed by a certified rater blinded to the treatment allocation. Each site must designate one or more individual(s) to perform these blinded assessments at 24 (16-36) hours, 6 ± 1 days or discharge (whichever is earlier), 30 days ± 7 days, and 90 days ± 30 days from randomization.
Neuroimaging core lab evaluation will also be assessed in a blinded manner, except for angiographic revascularization grading which will only be performed for the intra-arterial treatment arm.
Information on treatment allocation will be stored separately from the main study database. An unblinded independent statistician will combine treatment allocation data with the clinical data in order to report to the DSMB. A second blinded statistician will be part of the steering committee.
|Official Title:||The TESLA Trial: Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke|
|Actual Study Start Date :||July 16, 2019|
|Estimated Primary Completion Date :||February 16, 2023|
|Estimated Study Completion Date :||December 30, 2023|
No Intervention: Medical Management
Patients randomized to the medical therapy arm will receive standard medical therapy based on current AHA guidelines.
Experimental: Intra-arterial Therapy
For patients randomized to the intra-arterial therapy arm, sites will use local protocols for femoral access, sedation, heparin infusion, monitoring, etc. Mechanical thrombectomy will be performed with FDA-approved thrombectomy devices in accordance with the IFU.
Procedure: Intra-arterial Therapy
Mechanical Thrombectomy is a treatment for stroke that removes clots that block large blood vessels.
Other Name: Thrombectomy
- Utility-weighted 90-day Modified Rankin Score [ Time Frame: 90 days post randomization ]
Scale used 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. Scale ranges from 0-6 where 0 represents no symptoms and 6 represents death.
0 = No symptoms at all.
- = No significant disability despite symptoms; able to carry out all usual duties and activities.
- = Slight disability; unable to carry out all previous activities but able to look after own affairs without assistance.
- = Moderate disability requiring some help, but able to walk without assistance.
- = Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance.
- = Severe disability; bedridden, incontinent, and requiring constant nursing care and attention.
- = Death
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|Ages Eligible for Study:||18 Years to 85 Years (Adult, Older Adult)|
|Sexes Eligible for Study:||All|
|Accepts Healthy Volunteers:||No|
- 18 to 85 years of age
- Presenting with symptoms consistent with an acute ischemic stroke
- Imaging evidence of an anterior circulation occlusion of the Internal Carotid Artery (ICA) terminus and/or Middle Cerebral Artery Main Stem (MCA M1) segment
- NIHSS score >6 at the time of randomization
- Ability to randomize within 24 hours of stroke onset
- Pre-stroke mRS score 0-1
- Ability to obtain signed informed consent
Imaging evidence of moderate-large infarct defined as:
1. NCCT ASPECTS 2-5
- Females who are pregnant, or those of child-bearing potential with positive urine or serum beta Human Chorionic Gonadotropin (HCG) test
- Known severe allergy (more than a rash) to contrast media uncontrolled by medications
- Refractory hypertension (defined as persistent systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg)
CT evidence of the following conditions:
- Midline shift or herniation
- Evidence of intracranial hemorrhage
- Mass effect with effacement of the ventricles
- Computed Tomography Angiography (CTA) evidence suggestive of difficult endovascular access per the treating interventionalist
- Presence of cervical ICA occlusion (e.g., related to atherosclerotic disease or dissection)
- Rapidly improving neurological status prior to randomization to NIHSS <6
- Bilateral strokes or multiple intracranial occlusions
- Intracranial tumors
- Known hemorrhagic diathesis, coagulation factor deficiency, or on anticoagulant therapy with an International Normalized Ratio (INR) of >3.0 or Partial Thromboplastin Time (PTT) >3 times of normal
- Baseline platelet count <30,000 per microliter (µl)
- Life expectancy less than 90 days prior to stroke onset
- Participation in another randomized clinical trial that could confound the evaluation of the study
- Any other condition (in the opinion of the site investigator) that precludes an endovascular procedure or poses a significant hazard to the patient if an endovascular procedure was performed
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): NCT03805308
|Principal Investigator:||Albert J Yoo, MD, PhD||Texas Stroke Institute|
|Principal Investigator:||Osama O Zaidat, MD, MS||Mercy Health St. Vincent Medical Center|
|Responsible Party:||Dr. Osama O. Zaidat, Neuroscience and Stroke Medical Director, Mercy Health Ohio|
|Other Study ID Numbers:||
|First Posted:||January 15, 2019 Key Record Dates|
|Last Update Posted:||December 14, 2022|
|Last Verified:||December 2022|
|Individual Participant Data (IPD) Sharing Statement:|
|Plan to Share IPD:||No|
|Plan Description:||All shared data will be aggregate.|
|Studies a U.S. FDA-regulated Drug Product:||No|
|Studies a U.S. FDA-regulated Device Product:||No|
Central Nervous System Diseases
Nervous System Diseases