Intravenous Thrombolysis Plus Hypothermia for Acute Treatment of Ischemic Stroke

Stroke Clinical Trial

Official title:

Phase 1 Study of Intravenous Thrombolysis Plus Hypothermia for Acute Treatment of Ischemic Stroke

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00283088
• Other study ID #: P50NS44148LYDEN
• Status: Completed
• Phase: Phase 1
• First received: January 26, 2006
• Last updated: January 11, 2011
• Start date: October 2003
• Est. completion date: May 2009

Study information

• Verified date: January 2009
• Source: University of California, San Diego
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Food and Drug Administration
• Study type: Interventional

Clinical Trial Summary

The purpose of this trial is to evaluate if it is safe to use tissue plasminogen activator (tPA) within 6 hours of stroke onset when combined with hypothermia.

Description:

A stroke is usually caused by a blockage in one of the arteries that carries blood to the brain. Research has shown that tissue plasminogen activator (tPA)—a naturally occurring protein that opens blocked arteries by dissolving blood clots—activates the body's ability to dissolve recently formed blood clots and reduces or prevents the brain damage caused by a stroke.

The Food and Drug Administration (FDA) has approved the use of tPA for people having a stroke when taken within 3 hours of stroke onset, but not for those who arrive at the hospital more than 3 hours after stroke onset.

Researchers believe that a lower body temperature (hypothermia) may be beneficial while a stroke is happening because hypothermia may prevent further brain injury, or may make the stroke less damaging. In particular, hypothermia may make it possible to use tPA later than 3 hours after a stroke begins. This study will determine if it is safe to use tPA within 6 hours of the start of a stroke when combined with hypothermia.

Patients will receive a standard stroke evaluation, which includes blood tests, a computed tomography (CT) scan, complete physical and neurological examinations, and an electrocardiogram (EKG) to determine eligibility for the study.

Participants will be randomly assigned to a study group based on when their stroke began. Those who arrive at the hospital less than 3 hours from stroke onset will receive tPA alone or tPA with cooling (hypothermia). Those who arrive at the hospital 3 to 6 hours after stroke onset will be assigned to 1 of 4 groups—receiving either tPA alone, tPA with cooling, cooling alone, or standard medical care. Length of participation (including observation after the patient leaves the hospital) is 90 days.

This study is part of the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS), which allows researchers to enhance and initiate translational research that ultimately will benefit stroke patients by treating more patients in less than 2 hours, and finding ways to treat additional patients later.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 130
• Est. completion date: May 2009
• Est. primary completion date: October 2008
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years to 80 Years

Eligibility

Inclusion Criteria:

• Age 18 to 80

• All eligibility criteria for t-PA administration for acute ischemic stroke as outlined by the NINDS tPA Guidelines are met with the exception of time from onset

• Stroke onset within 6 hours prior to planned start of tPA

• Any subtype of ischemic stroke with NIHSS < 7 at the time hypothermia begins

Exclusion Criteria:

• Etiology other than ischemic stroke

• Item 1a on NIHSS>1 at the time of enrollment

• Symptoms resolving or NIHSS < 7 at the time hypothermia begins

• Contraindications to hypothermia, such as patients with known hematologic dyscrasias which affect thrombosis, (cryoglobulinemia, Sickle cell disease, serum cold agglutinins), or vasospastic disorders such as Raynaud's or thromboangiitis obliterans.

• Known co-morbid conditions likely to complicate therapy, e.g., end-stage cardiomyopathy, uncompensated arrhythmia, myopathy, liver disease severe enough to elevate bilirubin, history of pelvic or abdominal mass likely to compress inferior vena cava, IVC filters, dementia severe enough to prevent valid consent, end-stage AIDS, known thyroid deficiency, known renal insufficiency likely to impair meperidine (Demerol®) clearance

• Intracerebral hematoma

• Any intraventricular hemorrhage

• SBP > 185 or < 100; DBP > 110 or < 50 mmHg

• Pregnancy in women of child-bearing potential (must have pregnancy test, urine or blood, prior to therapy).

• Medical conditions likely to interfere with patient assessment

• Known allergy to meperidine (Demerol®)

• Currently taking MAO-I class of medication or used within previous 14 days

• Life expectancy < 3 months

• Not likely to be available for long-term follow-up.

Study Design

Allocation: Randomized, Endpoint Classification: Safety Study, Intervention Model: Factorial Assignment, Masking: Open Label, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Hypothermia
• Stroke

Intervention

Procedure:
• hypothermia
Hypothermia with or without tPA for stroke. Hypothermia is induced using the Celsius Control™ System. Subjects are stratified by time to six groups.

Drug:
• tissue plasminogen activator
tPA is a naturally occurring protein that opens blocked arteries by dissolving blood clots

Locations

Country	Name	City	State
United States	Hartford Hospital	Hartford	Connecticut
United States	Herman Memorial Hospital	Houston	Texas
United States	Stanford Medical Center	Palo Alto	California
United States	Scripps Mercy Hospital	San Diego	California
United States	University of California San Diego, Hillcrest Medical Center	San Diego	California
United States	University of California San Diego, Thornton Hospital	San Diego	California
United States	Saint Louis University Medical Center	St. Louis	Missouri

Sponsors (2)

Lead Sponsor	Collaborator
University of California, San Diego	National Institute of Neurological Disorders and Stroke (NINDS)

Country where clinical trial is conducted

United States, 

References & Publications (4)

Guluma KZ, Hemmen TM, Olsen SE, Rapp KS, Lyden PD. A trial of therapeutic hypothermia via endovascular approach in awake patients with acute ischemic stroke: methodology. Acad Emerg Med. 2006 Aug;13(8):820-7. Epub 2006 Jun 9. — View Citation

Hemmen TM, Lyden PD. Induced hypothermia for acute stroke. Stroke. 2007 Feb;38(2 Suppl):794-9. Review. — View Citation

Hemmen TM, Raman R, Guluma KZ, Meyer BC, Gomes JA, Cruz-Flores S, Wijman CA, Rapp KS, Grotta JC, Lyden PD; ICTuS-L Investigators. Intravenous thrombolysis plus hypothermia for acute treatment of ischemic stroke (ICTuS-L): final results. Stroke. 2010 Oct;41(10):2265-70. doi: 10.1161/STROKEAHA.110.592295. Epub 2010 Aug 19. — View Citation

Lyden PD, Allgren RL, Ng K, Akins P, Meyer B, Al-Sanani F, Lutsep H, Dobak J, Matsubara BS, Zivin J. Intravascular Cooling in the Treatment of Stroke (ICTuS): early clinical experience. J Stroke Cerebrovasc Dis. 2005 May-Jun;14(3):107-14. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Incidence and volume of hemorrhage on CT		48 hours post onset	Yes
Secondary	Incidence of AE and SAE		90 days post onset	Yes
Secondary	Mortality in both groups testing whether hypothermia improves mortality after stroke		90 Day	Yes
Secondary	NIHSS at the end of hypothermia		Hour 23.5 +/- 30 minutes of hypothermia	No
Secondary	Modified Rankin and NIHSS		30 and 90days	No
Secondary	CT lesion volume		30 days	No