Clinical trial NCT03210051: Remote Ischemic Conditioning Paired With Endovascular Treatment for Acute Ischemic Stroke (REVISE-1)
Official title: A Pilot Study Assessing the Safety and Feasibility of Remote Ischemic Conditioning Paired With Endovascular Treatment for Acute Ischemic Stroke
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE1
Conditions: Acute Stroke
Keywords: Acute ischemic stroke
Endovascular treatment
Remote ischemic conditioning
Reperfusion therapy
Neuroprotection
Lead sponsor: Capital Medical University
Sponsor class: OTHER
First posted: 2017-07-06
Enrollment: 20
Sex: ALL
Minimum age (years): 18
Maximum age (years): 90
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: DEVICE_FEASIBILITY

Brief summary: Currently, early reperfusion is considered as the most effective therapy for the treatment of acute ischemic stroke (AIS). Over the past 20 years, intravenous tissue plasminogen activator (IV tPA) has been demonstrated to be the only effective therapy for AIS. More recently, several large randomized clinical trials have concluded the superiority of endovascular mechanical thrombectomy for AIS. Furthermore, with the development of materials and techniques, the occluded artery can be recanalized with high percentage (60%-90%), and the rate of recanalization is still being improved. A great number of AIS patients are now eligible for revascularization therapy and there should be a good prognosis of AIS after recanalizing the occluded artery using mechanical thrombectomy. However, things are never as simple as wished to be. The rate of patients with functional independence is less than 50% and over 15% patients died at 3 months post thrombectomy. The discrepancy between the functional outcome and recanalization rates encourage researchers to explore strategies that further improving the functional outcome of AIS patients.

Remote ischemic conditioning has been demonstrated to reduce cerebral infarct size in mouse model of focal cerebral ischemia. And clinical researches demonstrated the protective effects of remote ischemic conditioning in AIS patient treated with IV tPA,. However, whether remote ischemic conditioning is safe and effective in protecting patients with large-vessel ischemic stroke and undergoing endovascular treatment is still unknown.

Detailed description: In the present study, the investigators will assess the safety and feasibility of remote ischemic condition paired with endovascular treatment for AIS. A single arm of AIS patients treated with endovascular therapy will be recruited, and remote ischemic conditioning will be applied prior to reperfusion therapy and in combination with post reperfusion therapy.

Eligibility criteria: Inclusion Criteria:

1. Acute ischemic stroke where patient is ineligible for intravenous thrombolytic treatment or the treatment is contraindicated, or where patient has received intravenous thrombolytic therapy without recanalization;
2. No remarkable pre-stroke functional disability (mRS ≤ 1);
3. Age ≥18 and ≤ 80;
4. Patient treatable within six hours of symptom onset;
5. Informed consent obtained from patient or acceptable patient's surrogate

Exclusion Criteria:

1. Identified hemorrhagic diathesis, coagulation factor deficiency, or oral anticoagulant therapy with INR \> 3.0;
2. Baseline platelet count \< 30\*109/L;
3. Baseline blood glucose of \< 2.7mmol/L or \>22.2mmol/L;
4. Renal insufficiency with creatinine ≥ 265 umol/L;
5. Severe, sustained hypertension (SBP \> 185 mmHg or DBP \> 110 mmHg);
6. Woman of childbearing potential who is known to be pregnant or lactating;
7. Subject participating in a study involving other drug or device trial study;
8. Patients with a pre-existing neurological or psychiatric disease that would confound the neurological or functional evaluations;
9. Unlikely to be available for 90-day follow-up;
10. Contraindication for remote ischemic conditioning: severe soft tissue injury, fracture, or peripheral vascular disease in the upper limbs;
11. Hypodensity on CT or restricted diffusion amounting to an ASPECTS score of \<7 on noncontrast CT;
12. CT or MRI evidence of hemorrhage;
13. Significant mass effect with midline shift on CT or MRI scans;
14. Subjects with artery occlusions in multiple vascular territories;
15. Evidence of intracranial tumor.

Primary outcomes:
measure: Number of participants with any RIC-related adverse events.
timeFrame: 0-90 days after endovascular treatment.
Secondary outcomes:
measure: Change in cerebral artery blood flow velocity
timeFrame: 0-7 days.
measure: Change in vital signs
timeFrame: 0-7 days.
measure: Change in intracranial pressure
timeFrame: 0-7 days.
measure: Change in plasma biomarkers
timeFrame: 0-7 days.
measure: Final cerebral infarct volume.
timeFrame: 5-9 days after endovascular treatment.
measure: Number of subjects completing all the designed RIC procedures.
timeFrame: 0-7 days.
measure: The severity of global disability at 90 days, as assessed by modified Rankin scale (mRS).
timeFrame: 0-90 days.
measure: Symptomatic Intracerebral Hemorrhage.
timeFrame: 0-90 days.
measure: Any adverse event.
timeFrame: 0-90 days.
Other outcomes:
Locations:
city: Beijing
country: China
facility: Xuanwu Hospital, Capital Medical University
Study officials:
References:
citation: Hausenloy DJ, Barrabes JA, Botker HE, Davidson SM, Di Lisa F, Downey J, Engstrom T, Ferdinandy P, Carbrera-Fuentes HA, Heusch G, Ibanez B, Iliodromitis EK, Inserte J, Jennings R, Kalia N, Kharbanda R, Lecour S, Marber M, Miura T, Ovize M, Perez-Pinzon MA, Piper HM, Przyklenk K, Schmidt MR, Redington A, Ruiz-Meana M, Vilahur G, Vinten-Johansen J, Yellon DM, Garcia-Dorado D. Ischaemic conditioning and targeting reperfusion injury: a 30 year voyage of discovery. Basic Res Cardiol. 2016 Nov;111(6):70. doi: 10.1007/s00395-016-0588-8. Epub 2016 Oct 20.
citation: Ren C, Wang P, Wang B, Li N, Li W, Zhang C, Jin K, Ji X. Limb remote ischemic per-conditioning in combination with post-conditioning reduces brain damage and promotes neuroglobin expression in the rat brain after ischemic stroke. Restor Neurol Neurosci. 2015;33(3):369-79. doi: 10.3233/RNN-140413.
citation: Meng R, Asmaro K, Meng L, Liu Y, Ma C, Xi C, Li G, Ren C, Luo Y, Ling F, Jia J, Hua Y, Wang X, Ding Y, Lo EH, Ji X. Upper limb ischemic preconditioning prevents recurrent stroke in intracranial arterial stenosis. Neurology. 2012 Oct 30;79(18):1853-61. doi: 10.1212/WNL.0b013e318271f76a. Epub 2012 Oct 3.