TNK-tPA Evaluation for Minor Ischemic Stroke With Proven Occlusion
Condition: Ischemic Stroke
MeSH terms: Stroke; Ischemic Stroke; Cerebral Infarction; Ischemia
Intervention: Tenecteplase
Intervention description: Tenecteplase will be given to the patient as an intravenous bolus over 1- 2 minutes within 90 minutes of the first slice of the CTA. This is an open-label trial, all patients will receive tenecteplase, either tier 1 or tier 2 dosage.
Intervention MeSH terms: Tenecteplase
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 50.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: Minor stroke

Summary:

      This trial will enroll patients that have been diagnosed with a transient ischemic attack
      (TIA) or minor stroke that has occurred within the past 12 hours. Anyone diagnosed with a
      minor stroke faces the possibility of long-term disability and even death, regardless of
      treatment. Stroke symptoms such as weakness, difficulty speaking and paralysis may improve or
      worsen over the hours or days immediately following a stroke. The purpose of this research
      trial is to study the effects of a clot-dissolving drug, tenecteplase (TNK-tPA), as a
      treatment for patients who arrive within twelve hours from stroke onset. This study is
      attempting to see if TNK-tPA given through a vein in the arm (intravenous) to patients is a
      safe treatment for stroke patients. Neither the safety nor the effectiveness of this
      treatment has been proven yet.

      This trial will be conducted at several site in Canada.

      Dr Michael Hill and Dr. Shelagh Coutts are the Principal Investigators of this trial,
      coordinated at the University of Calgary, Foothills Medical Centre.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Acute ischemic stroke in an adult patient (18 years of age or older)

          2. Onset (last-seen-well) time to treatment time < 12 hours.

          3. Minor stroke defined as a baseline NIHSS < 6 at the time of randomization. Patients
             must have a demonstrable neurological deficit on physical neurological examination.

          4. Any acute intracranial occlusion (MCA, ACA, PCA, VB territories) defined by
             non-invasive acute imaging (CT angiography) that is neurologically relevant to the
             presenting symptoms and signs. An acute occlusion is defined as TICI 0 or TICI 1 flow.

          5. Pre-stroke independent functional status in activities of daily living with pre-stroke
             estimated modified Barthel Index of 90 or greater AND premorbid mRS 0 or 1.

          6. Informed consent from the patient or surrogate.

          7. Patients can be treated within 90 minutes of the CT/CTA being completed.

        Exclusion Criteria:

          1. Hyperdensity on NCCT consistent with any intracranial hemorrhage. Any clinical
             suspicion of any intracranial hemorrhage even in the absence of visible blood on
             baseline brain imaging.

          2. Large acute stroke >1/3 MCA territory or ASPECTS<5 visible on baseline CT scan.

          3. Core of established infarction. No area of grey matter hypodensity at a similar or
             lesser density to white matter or in the judgment of the enrolling neurologist is
             consistent with a subacute ischemic stroke > 12 hours of age.

          4. Clinical history, past imaging and clinical judgment suggest that the intracranial
             occlusion is chronic.

          5. Patient is a candidate for and should receive standard of care IV tPA.

          6. Stroke occurring as an in-patient. An in-patient is a person who has been officially
             admitted to the hospital to a ward bed. A patient in the ED who has not been formally
             admitted is still considered to be an outpatient.

          7. Patient has a severe or fatal or disabling illness that will prevent improvement or
             follow-up or such that the treatment would not likely benefit the patient.

          8. Patient cannot complete follow-up due to co-morbid non-fatal illness or is visiting
             the host sites city and cannot return for follow-up.

          9. Pregnancy.

         10. Patient is actively taking dual antiplatelet medication (aspirin & clopidogrel) in the
             last 48 hours.

         11. International normalized ratio > 1.4

         12. Standard thrombolysis exclusions (Taken from Canadian guidelines1)

        NOTES: NIHSS = National Institutes of Health Stroke Scale ACA = anterior cerebral artery
        MCA = middle cerebral artery ICA = internal cerebral artery PCA = posterior cerebral artery
        VB = vertebrobasilar TICI = thrombolysis in cerebral ischemic scale CT = computed
        tomography NCCT = non-contrast CT CTA = CT angiography ASPECTS = Alberta Stroke Program
        Early CT Score IV = intravenous tPA = tissue plasminogen activator ED = Emergency
        Department