Middle Cerebral Artery Infarction
Conditions
Keywords
Intracranial hypertension, cerebral herniation, Stereotactic infarct tissue aspiration, fatality, disability
Brief summary
Malignant middle cerebral artery infarction(MMCI) has a high rate of disability and mortality. At present, there is no effective treatment except for craniotomy decompression, but the controversy of the craniotomy decompression still exists. The project is a prospective, randomized, single center, open label, clinical controlled trail. The eligible patients for enrollment are as follows: (1) malignant cerebral artery infarction within 48h onset; (2) craniotomy decompression can not be performed due to the contraindications, or refused by the patient or relatives. The patients are randomly assigned into 2 groups: (1)Medical therapy group: receiving osmotic therapy with mannitol and glycerol fructose，anti-platelet treatment, statins, and other symptomatic treatments such as controlling blood pressure, blood sugar, and infection, tracheal intubation or incision, etc; (2) Stereotactic infarct tissue aspiration (SITA) group: on the basis of medical treatment, receiving minimally invasive aspiration of infarct tissue 24-48 hours after stroke attacked. This study is aimed at comparing the efficacy and safety of of SITA in patients with MMCI.
Detailed description
Malignant middle cerebral artery infarction (MMCI) has a fatality rate of up to 80%, due to massive brain edema, increased intracranial pressure, and cerebral herniation. The herniation-induced death usually occured during the first week, despite aggressive osmotherapy with mannitol or hypertonic saline, sedation, and eventually hyperventilation, buffers, or hypothermia. A growing evidence show that decompression craniectomy (DC) can produce a significant reduction in mortality rate and an improvement in neurological outcome, but the controversy of the DC still exists. There is an urgent need to find a more effective treatment method. Given that brain tissue necrosis-induced edema and cerebral herniation is the key reason of fatality and disability of MMCI patients, the investigators argue that the reduction of cerebral tissue volume by stereotactic infarct tissue aspiration (SITA) is likely to reach the decompression effect similar to the DC. Recently, the investigators performed SITA in 2 MMCI patients who were qualified for decompressive craniectomy, but refused by patient relatives, and their neurological function significantly improved. The project is a prospective, randomized, single center, open label, clinical controlled trail. The eligible patients for enrollment are as follows: (1)ages from 40 to 90 years old; (2) malignant cerebral artery infarction within 48h onset; (3) craniotomy decompression can not be performed due to the contraindications, or refused by the patient or relatives. The patients are randomly assigned into 2 groups: (1) Medical therapy group: receiving osmotic therapy with mannitol and glycerol fructose，anti-platelet treatment, statins, and other symptomatic treatments such as controlling blood pressure, blood sugar, and infection, and tracheal intubation or incision, etc; (2) SITA group: receiving minimally invasive aspiration of infarct tissue 24-48 hours after stroke attacked on the basis of medical treatment. This study is aimed at comparing the efficacy and safety of of SITA in patients with MMCI.
Interventions
PROCEDUREStereotactic infarct tissue aspiration
The patient posed supine position to expose local skin and puncture point was located at 6.5 cm behind the hairline of the lesion side, and 5.0 cm lateral of midline. After routine skin preparation and disinfection, 5% lidocaine 2-5 ml was injected for local anesthesia. The skin was cut to expose periosteum by a scalpel. After skull was vertically drilled through with a 6mm diameter hole, a sterile tube with a needle in tube was put about 8 cm into centrum semiovale. The needle was put out and about 50ml necrosis brain tissue was aspirated by a 20 ml syringe. The tube was fixed into the skin about 2 cm after subcutaneous tunnel, and connected to the drainage bag. Surgical area was sterilized and wrapped by sterile gauze bandage.
OTHERMedical therapy
osmotic therapy with mannitol and glycerol fructose，anti-platelet treatment, statins, and other symptomatic treatments such as controlling blood pressure, blood sugar, and infection, and tracheal intubation or incision, etc
Sponsors
General Hospital of Shenyang Military Region
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
40 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
1. ages from 40 to 90 2. within 48 hours of onset 3. brain imaging confirmed malignant middle cerebral artery infarction (DWI+MRA) 4. infarction volume \> 145ml 5. craniotomy decompression can not be performed due to the contraindications, or refused by the patient or relatives 6. signed informed consent.
Exclusion criteria
1. hemorrhagic stroke 2. severe infection or severe disfunction of liver, kidney, hematopoietic system, endocrine system and other serious diseases 3. other clinical trials within 3 months 4. a negative attitude towards SITA by patient or relatives 5. other conditions not eligible for the trail judged by the researchers.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Modified Rankin Scale(mRS) 0-3 vs mRS 4-6 | 90±7days |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| National Institute of Health stroke scale(NIHSS) | 14±2days | NIHSS score improvement |
| Mean survival time | 1 year | — |
| death due to any reasons | 90±7days | — |
| mRS 0-4 compared with mRS 5 or 6 | 90±7days | — |
Other
| Measure | Time frame |
|---|---|
| The number of Local hemorrhage cases | 14±2 days |
| The number of intracranial hemorrhage cases | 14±2 days |
| Major cardiovascular events | during the surgery |
| The number of intracranial infection cases | 14±2 days |
| The number of Local infection cases | 14±2 days |
Countries
China
Outcome results
None listed