This site became the new ClinicalTrials.gov on June 19th. Learn more.
Show more
ClinicalTrials.gov Menu IMPORTANT: Listing of a study on this site does not reflect endorsement by the National Institutes of Health. Talk with a trusted healthcare professional before volunteering for a study. Read more...
ClinicalTrials.gov Menu IMPORTANT: Talk with a trusted healthcare professional before volunteering for a study. Read more...
ClinicalTrials.gov Menu
Give us feedback

Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease (MyRIAD)

This study is currently recruiting participants.
See Contacts and Locations
Verified July 2017 by Jose Romano, MD, University of Miami
Sponsor:
Collaborators:
University of California, Los Angeles
Northwestern University
Emory University
Baystate Medical Center
Information provided by (Responsible Party):
Jose Romano, MD, University of Miami
ClinicalTrials.gov Identifier:
NCT02121028
First received: April 18, 2014
Last updated: July 17, 2017
Last verified: July 2017
April 18, 2014
July 17, 2017
January 2015
February 2019   (Final data collection date for primary outcome measure)
Recurrent stroke in the territory of the symptomatic artery [ Time Frame: 1 year ]
Time to ischemic stroke in the territory of the symptomatic artery. Stroke is ascertained by the site neurologist and defined as new or worsening symptoms lasting >24 hours and associated with imaging evidence of ischemia on CT or MRI in the distribution of the stenotic artery.
Same as current
Complete list of historical versions of study NCT02121028 on ClinicalTrials.gov Archive Site
  • TIA in the territory of the stenotic artery [ Time Frame: 1 year ]
    TIA in the territory of the stenotic artery is defined as transient neurological symptoms lasting <24 hours and clearly related to the stenotic artery as per a neurologist.
  • Silent infarcts in the distribution of the stenotic artery [ Time Frame: 6-8 weeks ]
    Silent infarcts will be assessed by comparing the DWI and FLAIR sequences at baseline and at 6-8 weeks. Silent infarcts are defined as new discrete lesions not apparent in the baseline images that are in the distribution of the stenotic artery, in the absence of the primary endpoint.
  • TIA in the territory of the stenotic artery [ Time Frame: 1 year ]
    TIA in the territory of the stenotic artery is defined as transient neurological symptoms lasting <24 hours and clearly related to the stenotic artery as per a neurologist.
  • Silent infarcts in the distribution of the stenotic artery [ Time Frame: 4-6 weeks ]
    Silent infarcts will be assessed by comparing the DWI and FLAIR sequences at baseline and at 4-6 weeks. Silent infarcts are defined as new discrete lesions not apparent in the baseline images that are in the distribution of the stenotic artery, in the absence of the primary endpoint.
  • Risk of combined microembolic signals and impaired vasomotor reactivity. [ Time Frame: 1 year ]
    Assess the interaction of the presence of micro embolic signals, assessed by TCD and a marker of plaque emboligenecity, and impaired vasomotor reactivity, assessed by TCD and a marker of collateral flow limitation, in increasing the risk of recurrent stroke in the territory of the target artery.
  • Risk of combined poor ante grade flow and poor distal tissue perfusion. [ Time Frame: 1 year ]
    Assess the Interaction between two mechanisms of cerebral ischemia, poor antegrade flow assessed by quantitative MRA as a marker of flow across a stenotic arterial segment, and poor tissue perfusion assessed by perfusion MRI and representative of distal territorial perfusion, in the risk of recurrent stroke in the territory of the stenotic artery.
Same as current
 
Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease
Mechanisms of Early Recurrence in Intracranial Atherosclerotic Disease

The objective of this study is to determine the mechanisms of stroke in patients with Intracranial Atherosclerotic Disease (IAD) by specifically evaluating limitations of antegrade flow through the stenotic artery, distal tissue perfusion to the affected territory, and artery-to-artery embolism. The hypothesis is that non-invasive imaging biomarkers that stratify stroke risk and distinguish mechanisms of IAD. This prospective multicenter study will enroll 175 patients with recently symptomatic high-grade IAD. Patients will be studied within 21 days of the index event (allowing appropriate time to arrange for diverse imaging modalities), with the following advanced neuroimaging techniques to elucidate mechanisms of recurrent ischemia:

  • Quantitative magnetic resonance imaging (QMRA) to assess volumetric flow rate through the stenotic artery.
  • Magnetic resonance perfusion weighted imaging (PWI-MRI) to determine distal tissue perfusion.
  • Vasomotor reactivity by Transcranial Doppler using the breath-holding technique (BHI-TCD) to assess compensatory flow characteristics to the territory distal to the affected artery;
  • Transcranial Doppler with embolic signal monitoring to evaluate artery-to-artery embolism that reflects plaque instability.

Patients will receive standardized medical management and its effectiveness on blood pressure, lipid, and glycemic control will be monitored.

The primary outcome is recurrent stroke in the territory of the stenotic artery during a 1-year follow-up period; secondary outcomes are: a) new asymptomatic ischemic lesions on MRI in the distribution of the stenotic artery at 6-8 weeks, and b) transient ischemic attack (TIA) in the distribution of the stenotic artery during a 1-year follow-up period.

Patients will be recruited at various sites that will be trained and certified on the imaging techniques employed. Raw imaging data will be interpreted centrally.

Not Provided
Observational
Observational Model: Cohort
Time Perspective: Prospective
Not Provided
Not Provided
Non-Probability Sample
Eligible patients will have a recent stroke or TIA due to intracranial Atherosclerotic Disease (IAD) of 50-99% .
Intracranial Vascular Disorders
Not Provided
Intracranial Atherosclerotic Disease, Stroke/TIA
Stroke/TIA due to high grade IAD ≤21 days from symptom onset.
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
175
February 2019
February 2019   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  1. Stroke defined as symptoms lasting >24 hours and associated with imaging evidence of acute ischemia in the distribution of the stenotic vessel on CT or MRI.
  2. Eligible TIA defined as transient neurological symptoms lasting <24 hours, need to be:

    1. accompanied by DWI abnormalities in the distribution of the stenotic artery; or
    2. multiple (≥2), stereotyped events associated with unequivocal ischemic symptoms (weakness, aphasia), and attributed to the symptomatic artery.
  3. IAD should involve the intracranial carotid, middle cerebral, intracranial vertebral or basilar arteries.
  4. Stenosis 50-99% quantified by digital subtraction angiography (DSA), CT angiography-CTA or MR angiography-MRA tests. DSA is not required but will be used if obtained as part of clinical care.

    The criteria for 50-99% are:

    1. CTA or DSA: measured 50-99% stenosis by WASID criteria (percent stenosis = (1-[diameter stenosis/diameter normal]) x 100%.
    2. MRA: measured 50-99% stenosis or presence of a flow gap.
  5. Age >30; those 30-49 years of age must also have the presence of established atherosclerotic disease in another vascular bed (coronary, extracranial carotid, peripheral) or the presence of 2 or more risk factors (hypertension, diabetes mellitus, hyperlipidemia, tobacco abuse within the last 2 years).
  6. Enrollment within 21 days of symptom onset and completion of study imaging tests within 21 days of index event (stroke or TIA).
  7. Provide informed consent for participation in the study.

Exclusion Criteria:

  1. Other cause for stroke: atrial fibrillation, acute anterior wall ST-elevation myocardial infarction <30days, mitral stenosis, mechanical valve, intracardiac thrombus or vegetation, dilated cardiomyopathy or ejection fraction <30%, proximal extracranial carotid or vertebral stenosis >50%.
  2. Contraindications to MRI, including MR-incompatible metallic implants, implanted electronic devices, other potentially mobile ferromagnetic material, pregnancy (women in fertile age should have a negative pregnancy test), lactation, morbid obesity, and severe claustrophobia.
  3. Renal impairment defined as either a creatinine level >1.5 mg/dL or a glomerular filtration rate (GFR) <30 mL/min/1.73 m2.
  4. Known allergy to gadolinium.
  5. Unable to obtain informed consent by patient or legally authorized representative.
  6. Severe behavioral or social problems that may interfere with the conduct of the study.
  7. In the investigator's opinion, patient unlikely return for follow up visit and to complete the study.
  8. Participation in a drug or device clinical trial within the last 30 days.
Sexes Eligible for Study: All
30 Years to 99 Years   (Adult, Senior)
No
Contact: Jose G Romano, MD 305-243-8018 jromano@med.miami.edu
Contact: Iszet C Bustillo, MD, MPH 305-243-8018 icampo@med.miami.edu
United States
 
 
NCT02121028
20140056
No
Not Provided
Not Provided
Jose Romano, MD, University of Miami
University of Miami
  • University of California, Los Angeles
  • Northwestern University
  • Emory University
  • Baystate Medical Center
Principal Investigator: Jose G Romano, MD University of Miami
Principal Investigator: Shyam Prabhakaran, MD Northwestern University
Principal Investigator: David S Liebeskind, MD University of California, Los Angeles
University of Miami
July 2017

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP