None listed
Conditions
Brief summary
The posterior cerebral artery (PCA) is an important artery which supplies the visual cortex in the occipital lobe and is key to visual function in the contralateral hemifield (loss of half visual field on side opposite to the stroke). Preservation of vision is essential in reading, return to work and driving post-stroke (deficit less than quarter of visual field). Unfortunately, spontaneous complete recovery of visual field occurs in 18.4% of cases and visual rehabilitation does not reduce hemifield deficit. The aim of this trial is to determine if clot extraction versus best medical therapy is the optimal treatment.
Interventions
:Patients randomized to the thrombectomy arm will have clot extraction or aspiration catheter in the angiographic suite. This decision is up to the interventional radiologists performing the procedure. The procedure may take 1 hour but can be longer for complex anatomy or clot. Following the procedure the interventional neuroradiologists will document the procedure in electronic medical record. Post-intervention: A non-contrast CT and CTA will be performed 24-to-48-hour post intervention. At th
:Patients randomized to the thrombectomy arm will have clot extraction or aspiration catheter in the angiographic suite. This decision is up to the interventional radiologists performing the procedure. The procedure may take 1 hour but can be longer for complex anatomy or clot. Following the procedure the interventional neuroradiologists will document the procedure in electronic medical record. Post-intervention: A non-contrast CT and CTA will be performed 24-to-48-hour post intervention. At the investigator’s discretion, a repeat CT Perfusion or MRI may be performed at 24-to-48 hr.
Sponsors
National Health and Medical Research Council Clinical Trial and Cohort
Study design
Allocation
Randomised controlled trial
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Inclusion criteria: 1. Patients presenting with acute ischaemic stroke within 9 hours of stroke onset 2. Hemifield deficit 3. Pre-stroke modified Rankin Score (mRS) score of 0 or 1 or 2 4. Patient’s age is equal or greater than18 years (or as per local requirements) 5. Endovascular therapy expected to commence (arterial puncture) within 90 minutes of initial non-contrast CT brain. 6. Arterial occlusion on CT Angiography (CTA) or MR Angiography (MRA) of the posterior cerebral artery/PCA (P1 or P2).
Exclusion criteria
Exclusion criteria: 1. Patients presenting with acute ischaemic stroke greater than 24 hours of stroke onset 2. Intracerebral haemorrhage (ICH) identified by CT or MRI 3. Rapidly improving symptoms at the discretion of the investigator 4. Pre-stroke modified Rankin Score (mRS) score of 2 or more (indicating previous disability) 5. Hypodensity in greater than 1/2 PCA territory on non-contrast CT 6. Basilar artery occlusion ipsilateral to the PCA clot 7. Contraindication to imaging with contrast agents 8. Any terminal illness such that the patient would not be expected to survive more than 1 year. 9. Patients with active cancer and undergoing treatment for cancer are excluded, 10. Any condition that, in the judgment of the investigator, could impose hazards to the patient if study therapy is initiated or affect the participation of the patient in the study. 11. Pregnant women
Outcome results
None listed