Stroke, Acute, Stroke, Ischemic
Conditions
Keywords
Acute Ischemic Stroke, LF-rTMS, Phase 2 Pilot Trial
Brief summary
This is a multicenter, open-label, evaluator-blinded, investigator-initiated, randomized clinical trial, to evaluate the clinical efficacy and safety of LF-rTMS in reducing infarct size, reducing disability rate and improving functional outcome in patients with acute ischemic stroke within 48 hours after stroke onset.
Detailed description
The target population of this study was patients with clinically diagnosed AIS who had an acute occlusion of the responsible vessel in the anterior circulation and were not scheduled for intravenous thrombolysis and/or endovascular therapy, the time from stroke onset to the start of study intervention was less than 48-hours. Enrolled patients were randomly assigned in a 1:1 ratio to either the"LF-rTMS group" or the"Control group" to receive: 1. LF-rTMS group: H 4 Coil (stimulation site: prefrontal cortex, insular lobe),1-Hz rTMS, stimulation intensity RMT 100%,1200 pulses/session, two sessions (2400 pulses)/day (interval ≥2 hours), lasting about half an hour each time, the total duration of treatment was 3 days (6 sessions,7200 pulses). 2. Control group: received routine treatment. All the above therapeutic interventions were conducted by trained TMS operators. Except for the study intervention, the subjects in both groups received clinical routine diagnosis and treatment which were not affected by the intervention. All patients were followed up until the 90th day after randomization to evaluate the clinical efficacy and safety of LF-rTMS in reducing infarct size, reducing disability rate and improving functional outcome in patients with acute ischemic stroke within 48 hours after stroke onset.
Interventions
DEVICELF-rTMS
H 4 Coil (stimulation site: prefrontal cortex, insular lobe),1-Hz rTMS, stimulation intensity RMT 100%,1200 pulses/session, two sessions (2400 pulses)/day (interval ≥2 hours), lasting about half an hour each time, the total duration of treatment was 3 days (6 sessions,7200 pulses).
Sponsors
Beijing Tiantan Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The investigators involved in the clinical evaluation of the patients remained blinded to treatment grouping.
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Age 18-80 years, gender is not limited; 2. Acute ischemic stroke of anterior circulation was diagnosed clinically 3. mRS 0-1 score before onset; 4. 6 ≤ NIHSS ≤25 at randomization; 5. Within 48 hours of stroke onset; 6. No thrombolysis therapy or thrombectomy is planned; 7. Obtain informed consent signed by the patient himself or by his legal authorized representative.
Exclusion criteria
1. TMS contraindications include metallic foreign bodies in the head, pacemaker, implantable drug pumps, cochlear implants, etc. 2. Epilepsy or history of epilepsy, intracranial hypertension, tumor and other serious neurological disorders; 3. Midline displacement and brain parenchymal mass effect seen in head CT and other images; 4. Head CT or MRI showed bilateral acute cerebral infarction, brainstem infarction, or insular infarction; 5. Evidence of acute intracranial hemorrhage; 6. A history of congenital or acquired hemorrhagic disease, coagulation factor deficiency, or thrombocytopenia disease; 7. After blood pressure control, the systolic blood pressure was still ≥180 mmHg or the diastolic blood pressure was ≥110 mmHg; 8. Known recent or current serum creatinine exceeding 1.5 times the upper limit of normal or estimated glomerular filtration rate (EGFR) \< 60 mL/min; 9. Patients during pregnancy or lactation and within 90 days of planned pregnancy; 10. Patients with severe mental disorders or dementia who can not cooperate with informed consent and follow-up; 11. Patients with malignancy or severe systemic disease and expected survival of less than 90 days; 12. Participants in other clinical intervention studies within 30 days before randomization or who were participating in other clinical intervention studies.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Infarct growth from baseline to Day 3 (mL) | 3 days | Infarct growth at 3 days was calculated as the absolute difference between the baseline core infarct volume and the 3 days post-randomization infarct volume. Positive values indicate infarct growth. |
| Symptomatic intracranial hemorrhage | 3 days | The proportion of symptomatic intracranial hemorrhage |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of Early neurological improvement (ENI) | 3 days | Proportion of patients with a reduction of ≥4 on the NIHSS, compared with the baseline score or an NIHSS of 0 or 1 |
| Final infarct volume at Day 3 (mL) | 3 days | Final infarct volume, in milliliters, measured 3 days after randomization. |
| Change in NIHSS score from baseline to Day 3 | 3 days | Change in NIHSS score from baseline to Day 3 |
| Proportion of participants with modified Rankin Scale score 0 to 1 at Day 90 | 90 days | Proportion of participants with modified Rankin Scale score 0 to 1 at Day 90 |
| Proportion of participants with modified Rankin Scale score 0 to 2 at Day 90 | 90 days | Proportion of participants with modified Rankin Scale score 0 to 2 at Day 90 |
| Barthel index of ADL | 90 days | Barthel index of ADL, 0-100 (better) |
| EQ-5D-5L | 90 days | The Health Questionnaire (EQ-5D-5L) is a self-report survey that measures quality of life across 5 domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension is scored on a 5-level severity ranking that ranges from "no problems" through "extreme problems." |
| Montreal Cognitive Assessment (MoCA) total score | 90 days | Total score of the MoCA Performance on the MoCA (0-30; higher score indicates better performance) |
| Number of participants with neurological deterioration within 3 days | 3 days | The incidence of deterioration of neurological function (NIHSS increase ≥4 points) |
| Number of participants with symptomatic intracranial hemorrhage within 90 days | 90 days | Number of participants with symptomatic intracranial hemorrhage within 90 days |
| All-cause deaths | 90 days | The proportion of all-cause deaths |
| Stroke recurrence | 90 days | Recurrence rate of symptomatic stroke (cerebral infarction, cerebral hemorrhage) |
| Serious adverse events | 90 days | The proportion of serious adverse events (SAE) |
| Adverse events (AE) | 90 days | The proportion of adverse events (AE) |
Countries
China
Contacts
PRINCIPAL_INVESTIGATORYongjun Wang, MD
Beijing Tiantan Hospital
Outcome results
None listed