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Combined Use of Contact Aspiration and the Stent Retriever Technique Versus Stent Retriever Alone for Recanalisation in Acute Cerebral Infarction (ASTER2)

This study is currently recruiting participants.
Verified November 2017 by Hopital Foch
Sponsor:
ClinicalTrials.gov Identifier:
NCT03290885
First Posted: September 22, 2017
Last Update Posted: November 8, 2017
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.
Information provided by (Responsible Party):
Hopital Foch
September 19, 2017
September 22, 2017
November 8, 2017
October 16, 2017
February 28, 2020   (Final data collection date for primary outcome measure)
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)
Same as current
Complete list of historical versions of study NCT03290885 on ClinicalTrials.gov Archive Site
  • 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
Same as current
Not Provided
Not Provided
 
Combined Use of Contact Aspiration and the Stent Retriever Technique Versus Stent Retriever Alone for Recanalisation in Acute Cerebral Infarction
Combined Use of Contact Aspiration and the Stent Retriever Technique Versus Stent Retriever Alone for Recanalisation in Acute Cerebral Infarction: the Randomized ASTER2 Study

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.

Not Provided
Interventional
Not Provided
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Other
Acute Ischemic Stroke
  • 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
  • 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.

  • Experimental: Combined use of contact aspiration and stent retriever
    Combined use of contact aspiration and stent retriever mechanical thrombectomy for recanalization
    Intervention: Combination Product: Combined contact aspiration/Stent Retriever Technique
  • Active Comparator: Stent retriever mechanical thrombectomy alone
    Stent retriever mechanical thrombectomy alone for recanalisation
    Intervention: Device: Stent retriever technique
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
408
February 28, 2020
February 28, 2020   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Age 18 and older (i.e., candidates must have had their 18th birthday)
  • Groin puncture carried out within 8 hours of first symptoms
  • Neuroimaging demonstrates large vessel proximal occlusion (distal ICA through MCA bifurcation, M1 or M2)
  • Consenting requirements met according to French laws.
  • With or without intravenous thrombolysis

Exclusion Criteria:

  • Absence of large vessel occlusion on non-invasive imaging
  • Known or suspected pre-existing (chronic) large vessel occlusion in the symptomatic territory
  • Suspected pregnancy; if, a woman is of childbearing potential, a urine or serum beta human chorionic gonadotropin (betaHCG) test is positive.
  • Severe contrast medium allergy or absolute contraindication to iodinated agents.
  • Patient has severe or fatal comorbidities that will likely prevent improvement or follow-up or that will render the procedure unlikely to benefit the patient.
  • Acute ischemic stroke involving posterior circulation (vertebrobasilar occlusion)
  • Angiographic evidence of carotid dissection or tandem cervical occlusion or stenosis requiring treatment.
  • Patients benefiting from a legal protection
  • Non-membership of a national insurance scheme
  • Opposition of the patient or (in case of inclusion as a matter of urgency) of the trustworthy person
Sexes Eligible for Study: All
18 Years and older   (Adult, Senior)
No
Contact: Bertrand Lapergue, MD +33(0)146257343 b.lapergue@hopital-foch.org
France
 
 
NCT03290885
2017014F
2016-A01735-46 ( Other Identifier: ANSM )
No
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Not Provided
Hopital Foch
Hopital Foch
Not Provided
Principal Investigator: Bertrand Lapergue, MD Hôpital Foch
Study Chair: Michel Pottin, MD Fondation Ophtalmologique de Rothschild
Hopital Foch
November 2017

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