Brain Diseases, Central Nervous System Diseases, Cerebrovascular Disorders, Intracranial Arterial Calcification, Ischemic Stroke, Nervous System Diseases, Stroke, Stroke, Acute, Vascular Diseases
Conditions
Keywords
Acute ischemic stroke, Large vessel occlusion, Mechanical thrombectomy, Endovascular treatment, Agatston score, Prospective cohort study, Intracranial atherosclerotic disease
Brief summary
CAIS-MT is a single-center, prospective cohort study, to evaluate the correlation between outcomes of endovascular treatment(EVT) and intracranial artery calcification(IAC) in patients with acute ischemic stroke due to large or medium vessel occlusion.
Detailed description
This study have to objective to evaluate the predictive value of IAC Agatston score in patients with acute ischemic stroke due to large or medium vessel occlusion on worse angiographic and functional outcomes after EVT. The result of this study will provide a upfront basis for risk stratification of adverse outcomes of EVT by using quantitative IAC, so as to get a reference for an individualized and precise plan of EVT.
Interventions
None listed
Sponsors
Zhujiang Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Male or non-pregnant women with acute stroke symptoms aged over 18 years. * Occlusion of the intracranial internal carotid artery, the middle cerebral artery, the anterior cerebral artery, the posterior cerebral artery, basilar artery and intracranial vertebral artery confirmed by CT, MR angiography, or digital subtraction angiography. * No absolute contraindication to iodinated contrast media. * Planned treatment with EVT by clinical care team. * Informed consent obtained from patients or their legal representatives. * Willing to be followed up as required by the clinical study protocol.
Exclusion criteria
* Acute ischemic stroke occurs over 24 hours of time last known well. * Neurologic deficits caused by diagnoses other than ischemic stroke, such as intracerebral hemorrhage, subarachnoid hemorrhage, or intracranial tumors. * With other underlying factors leading to IAC, such as hyperthyroidism, end-stage renal disease, long-term oral intake of vitamin K antagonist(Warfarin), chronic vitamin D deficiency or overdose, persistent hypomagnesemia, persistent hypercalcemia, persistent hyperphosphatemia and high oral calcium intake. * Lack of non-contract CT images on admission and significant artifacts in CT images preventing IAC measurement. * Severe renal insufficiency (estimated glomerular filtration rate \< 30ml/min or serum creatinine \> 220μmol/L (2.5mg/dl)). * Previous cerebrovascular intervention treatment or craniotomy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients with a adverse functional outcome at 3 months | 90(±7) days | Modified Rankin Scale(mRS) score \> 2 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of patients without disability at 3 months | 90(±7) days | mRS score 0-1 |
| Proportion of patients with functional independence at 3 months | 90(±7) days | mRS score 0-2 |
| Proportion of patients ambulatory or bodily needs-capable or better at 3 months | 90(±7) days | mRS score 0-3 |
| Change of the NIHSS score at 24 hours from baseline | 24 hours | Change of the NIHSS score at 24 hours from baseline |
| Health-related quality of life at 3 months | 90(±7) days | Health-related quality of life is assessed with the European Quality Five Dimensions Five Level scale (EQ-5D-5L) |
| Proportion of substantial reperfusion at final angiogram | 0 day | Substantial reperfusion is defined as a expanded Treatment in Cerebral Infarction score of 2b50 (50 to 67% reperfusion), 2b67 (67 to 89% reperfusion), 2c(90 to 99% reperfusion) or 3 (complete reperfusion) |
| Proportion of substantial reperfusion at final angiogram without any rescue methods | 0 day | Substantial reperfusion is defined as a expanded Treatment in Cerebral Infarction score of 2b50 (50 to 67% reperfusion), 2b67 (67 to 89% reperfusion), 2c(90 to 99% reperfusion) or 3 (complete reperfusion) |
| Proportion of substantial reperfusion at first angiogram | 0 day | Substantial reperfusion is defined as a expanded Treatment in Cerebral Infarction score of 2b50 (50 to 67% reperfusion), 2b67 (67 to 89% reperfusion), 2c(90 to 99% reperfusion) or 3 (complete reperfusion) |
| Change of the NIHSS score at 6 days or discharge if earlier from baseline | 6(±1) days | Change of the NIHSS score at 6 days or discharge if earlier from baseline |
| Proportion of patients with any ICH within 48 hours | Within 48 hours | ICH will be evaluated according to the Heidelberg Bleeding Classification. |
| Mortality at 3 months | 90(±7) days | Mortality rates are defined as the number of deaths observed divided by the number of subjects observed over the 90-day study period. |
| Incidence of serious adverse events | Within 3 years | Including but not limited to acute respiratory failure, severe or malignant cerebral artery infarction, acute heart failure, debridement decompression, and other major medical events that can result in death, immediately life-threatening, hospitalization or prolongation of this hospitalization, terminally or severely disabling/incapacitating, the loss of a significant ability to maintain normal life functioning, or medical intervention to avoid the above outcomes. |
| Procedure-related complications | Up to 24 hours | such as arterial perforation, iatrogenic arterial dissection, embolization in previously uninvolved vascular territory, arterial access site hematoma, and retroperitoneal hematoma. Arterial perforation will be defined at angiography by the operator and associated with subarachnoid hemorrhage. Iatrogenic arterial dissection will be defined at angiography by the operator. Arterial access site hematoma will be assessed as a complication of arterial access puncture and defined by clinical examination and anatomic imaging. Retroperitoneal hematoma will be assessed as a complication of groin puncture and defined by imaging (ultrasound or CT or MR angiography). The definition of embolization in previously uninvolved vascular territory is noted after recanalization of the primary occlusion site, any vessel occlusions distal from the primary occlusion site are considered emboli due to periprocedural thrombus fragmentation. |
| Proportion of patients with new cerebrovascular events related with previous vessel occlusion at 1 year | 365(±30) days | New cerebrovascular events are defined as progression of ischemic lesion or newly hemorrhagic lesion. |
| Proportion of patients with new cerebrovascular events related with previous vessel occlusion at 3 years | 1095(±30) days | New cerebrovascular events are defined as progression of ischemic lesion or newly hemorrhagic lesion. |
| Proportion of patients with new cerebrovascular events irrelated with previous vessel occlusion at 1 year | 365(±30) days | New cerebrovascular events are defined as progression of ischemic lesion or newly hemorrhagic lesion. |
| Proportion of patients with new cerebrovascular events irrelated with previous vessel occlusion at 3 years | 1095(±30) days | New cerebrovascular events are defined as progression of ischemic lesion or newly hemorrhagic lesion. |
| Proportion of patients with Symptomatic intracranial hemorrhage(sICH) within 48 hours | Within 48 hours | ICH will be evaluated according to the Heidelberg Bleeding Classification. sICH is diagnosed if the new observed ICH is associated with any of the following conditions: 1) NIHSS score increased more than 4 points than that immediately before worsening; 2) NIHSS score increased more than 2 points in one category; 3) Deterioration led to intubation, hemicraniectomy, external ventricular drain placement or any other major interventions. Additionally, the symptom deteriorations could not be explained by causes other than the observed ICH. |
Countries
China
Contacts
Primary ContactFeng Xin, MD
Backup ContactWen Zhuohua, MD
Outcome results
None listed