Intracranial Hemorrhages
Conditions
Keywords
Intracranial Hemorrhages, remote ischemic conditioning
Brief summary
The purpose of this study is to determine whether treatment with remote ischemic conditioning is of sufficient promise to improve outcome before conducting a larger clinical trial to examine its effectiveness as a treatment for intracerebral hemorrhage.
Detailed description
Intracerebral hemorrhage is a devastating disease with a high rate of severe disability and death, while no specific treatment has been proven to improve functional outcome. As a result, new approaches need to be developed to treat intracerebral hemorrhage. Animal and human trials showed treatment with remote ischemic conditioning was safe for intracerebral hemorrhage. And repetitive remote ischemic conditioning has been shown to improve sensorimotor and neuropathological outcomes following experimental hemorrhagic stroke. Therefore, we hypothesize that repetitive remote ischemic conditioning could improve functional outcome in patients with intracerebral hemorrhage. We design this prospective, multicenter, randomized controlled double-blind trial to determine whether treatment with remote ischemic conditioning is of sufficient promise to improve outcome before conducting a larger clinical trial to examine its effectiveness as a treatment for intracerebral hemorrhage.
Interventions
PROCEDURERemote ischemic conditioning
Remote ischemic conditioning (RIC) is induced by 4 cycles of 5 min of healthy upper limb ischemia followed by 5 min reperfusion. Limb ischemia was induced by inflations of a blood pressure cuff to 200 mm Hg. RIC will be conducted twice daily for 7 days.
PROCEDURESham remote ischemic conditioning
Sham remote ischemic conditioning (Sham RIC) is simulated by the measurement of blood pressure twice daily for 7 days.
Sponsors
Yi Yang
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age ≥ 18 years 2. Supratentorial intracerebral hemorrhage confirmed by brain CT scan 3. Functional independence prior to ICH, defined as pre-ICH mRS ≤ 1 4. NIHSS score ≥ 4 and GCS ≥ 6 upon presentation 5. Able to commence RIC treatment within 12 hours of stroke onset 6. Signed and dated informed consent is obtained.
Exclusion criteria
1. Definite evidence of secondary ICH, such as structural abnormality, brain tumor, thrombolytic drug, and other causes 2. A very high likelihood that the patient will die within the next 24 hours on the basis of clinical and/or radiological criteria 3. Already booked for surgical treatment 4. Life expectancy of less than 90 days due to comorbid conditions 5. Severe hematologic disease 6. Concurrent use of anticoagulation drugs including Warfarin, dabigatran, rivaroxaban. 7. Concurrent use of glibenclamide or nicorandil 8. Any soft tissue, orthopedic, or vascular injury, wounds or fractures in healthy upper limb which may pose a contraindication for application of RIC 9. Severe hepatic and renal dysfunction 10. Platelet count \<100×10\^9/L 11. Coagulopathy defined as INR,APTT,and PT beyond the upper limit of normal range 12. Known pregnancy, or positive pregnancy test, or breastfeeding 13. Patients being enrolled or having been enrolled in other clinical trial within 3 months prior to this clinical trial 14. A high likelihood that the patient will not adhere to the study treatment and follow up regimen 15. Patients unsuitable for enrollment in the clinical trial according to investigators decision making.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients with Modified Rankin Scale (mRS) Score 0-2 | 3 months | The primary outcome measure of efficacy is the modified Rankin Scale (mRS) score, dichotomized to define good functional outcome as mRS 0-2 at 90 days. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Frequency of adverse events | 3 months | The safety endpoints will include all adverse events until day-7 or discharge (whichever is earlier), and severe adverse events through day-90 after the onset of intracerebral hemorrhage. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Proportion of hematoma growth | 24 hours | The proportional growth in hematoma volume during the first 24h after the onset of intracerebral hemorrhage. |
| Proportion of hematoma absorption | 14 days | The proportional change in hematoma volume between 24h and 14 days or discharge (whichever is earlier) after the onset of intracerebral hemorrhage. |
| Changes of hematological indicators | 24 hours; 7 days | The changes of hematological indicators (inflammatory cytokine,et al.) during the first 24h and 7 days after the onset of intracerebral hemorrhage. |
Countries
China
Contacts
Primary ContactYi Yang, MD, PhD
Backup ContactZhenni Guo, MD
Outcome results
None listed