CClinicalTrials.gg
CompletedNCT03805308TESLAUpdated Apr 23, 2024

The TESLA Trial: Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke

An interventional study of Intra-arterial Therapy in Ischemic Stroke, sponsored by Mercy Health Ohio. Completed at 43 sites in United States. Open to participants aged 18 Years to 85 Years. Per ClinicalTrials.gov, last updated 2024-04-23.

Sponsored by Mercy Health Ohio · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
300
Allocation
Randomized
Ages
18 Years to 85 Years
Sex
All
01

Study summary

The primary objective of the trial is to establish the effectiveness of IAT (versus medical management) in patients with moderate-large infarcts (NCCT ASPECTS 2-5) at baseline, with adaptive enrichment to better define the upper limit of infarct volume for treatment eligibility. Furthermore, the investigators aim to determine whether certain subgroups of patients with large baseline infarcts will have a greater treatment benefit. Finally, the investigators will assess the agreement of ASPECTS scores between site investigators, the core imaging lab, and automated software.

Read the detailed description

Prospective, randomized, open-label, blinded endpoint study. Patients presenting with symptoms of AIS who have evidence of a moderate-large infarct volume (Non-contrast CT Alberta Stroke Program Early CT score [NCCT ASPECTS] 2-5 in the anterior circulation will be assigned to either best medical management alone (including IV rtPA) or intra-arterial treatment (IAT) with mechanical thrombectomy added to best medical management. Each treated patient will be followed and assessed for 3 months after randomization.

02

Conditions studied

  • Ischemic Stroke

Keywords

  • Stroke
  • Ischemic Stroke
  • Thrombectomy
03

Who can participate

Ages eligible
18 Years to 85 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  1. 18 to 85 years of age
  2. Presenting with symptoms consistent with an acute ischemic stroke
  3. Imaging evidence of an anterior circulation occlusion of the Internal Carotid Artery (ICA) terminus and/or Middle Cerebral Artery Main Stem (MCA M1) segment
  4. NIHSS score >6 at the time of randomization
  5. Ability to randomize within 24 hours of stroke onset
  6. Pre-stroke mRS score 0-1
  7. Ability to obtain signed informed consent

Imaging evidence of moderate-large infarct defined as:

  1. NCCT ASPECTS 2-5

Exclusion criteria

Exclusion Criteria:

  1. Females who are pregnant, or those of child-bearing potential with positive urine or serum beta Human Chorionic Gonadotropin (HCG) test
  2. Known severe allergy (more than a rash) to contrast media uncontrolled by medications
  3. Refractory hypertension (defined as persistent systolic blood pressure >185 mmHg or diastolic blood pressure >110 mmHg)
  4. CT evidence of the following conditions:

    • Midline shift or herniation
    • Evidence of intracranial hemorrhage
    • Mass effect with effacement of the ventricles
  5. Computed Tomography Angiography (CTA) evidence suggestive of difficult endovascular access per the treating interventionalist
  6. Presence of cervical ICA occlusion (e.g., related to atherosclerotic disease or dissection)
  7. Rapidly improving neurological status prior to randomization to NIHSS \<6
  8. Bilateral strokes or multiple intracranial occlusions
  9. Intracranial tumors
  10. Known hemorrhagic diathesis, coagulation factor deficiency, or on anticoagulant therapy with an International Normalized Ratio (INR) of >3.0 or Partial Thromboplastin Time (PTT) >3 times of normal
  11. Baseline platelet count \<30,000 per microliter (µl)
  12. Life expectancy less than 90 days prior to stroke onset
  13. Participation in another randomized clinical trial that could confound the evaluation of the study
  14. Any other condition (in the opinion of the site investigator) that precludes an endovascular procedure or poses a significant hazard to the patient if an endovascular procedure was performed
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
300 participants (actual)

Study arms

  • No intervention
    Medical Management

    Patients randomized to the medical therapy arm will receive standard medical therapy based on current AHA guidelines.

  • Experimental
    Intra-arterial Therapy

    For patients randomized to the intra-arterial therapy arm, sites will use local protocols for femoral access, sedation, heparin infusion, monitoring, etc. Mechanical thrombectomy will be performed with FDA-approved thrombectomy devices in accordance with the IFU.

    Procedure: Intra-arterial Therapy

Interventions

  • ProcedureIntra-arterial Therapy

    Mechanical Thrombectomy is a treatment for stroke that removes clots that block large blood vessels.

    Also known as: Thrombectomy

05

What researchers measure

Primary outcomes

  1. Utility-weighted 90-day Modified Rankin Score

    Scale used for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. Scale ranges from 0-6 where 0 represents no symptoms and 6 represents death. 0 = No symptoms at all. 1. = No significant disability despite symptoms; able to carry out all usual duties and activities. 2. = Slight disability; unable to carry out all previous activities but able to look after own affairs without assistance. 3. = Moderate disability requiring some help, but able to walk without assistance. 4. = Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance. 5. = Severe disability; bedridden, incontinent, and requiring constant nursing care and attention. 6. = Death

    Time frame: 90 days post randomization

06

Study locations

43 sites
  • Baptist Health Center for Clinical Research
    Little Rock, Arkansas 72205, United States
  • PIH Health Good Samaritan Hospital and PIH Health Whittier Hospital
    Los Angeles, California 90017, United States
  • Pomona Valley Hospital Medical Center
    Pomona, California 91767, United States
  • Sutter Institute for Medical Research
    Sacramento, California 95816, United States
  • California Pacific Medical Center & Mills Peninsula Medical Center
    San Francisco, California 94107, United States
  • Los Robles Hospital and Medical Center
    Thousand Oaks, California 91360, United States
  • Providence Saint John's Health Center
    Torrance, California 90503, United States
  • Boca Raton Regional Hospital Inc.
    Boca Raton, Florida 33486, United States
  • University of Miami
    Coral Gables, Florida 33146, United States
  • Tenet Health Systems (Delray Medical Center, St. Mary's Medical Center, Palmetto General Hospital)
    Delray Beach, Florida 33484, United States
  • Orlando Health Inc.
    Orlando, Florida 32806, United States
  • University of South Florida
    Tampa, Florida 33612, United States
  • Wellstar Health System, Inc.
    Marietta, Georgia 30062, United States
  • The University of Chicago
    Chicago, Illinois 60637, United States
  • Northwestern University
    Evanston, Illinois 60208, United States
  • AMITA Resurrection Medical Center and AMITA Saint Joseph Medical Center
    Lisle, Illinois 60532, United States
  • Central DuPage Hospital Association d/b/a Northwestern Medicine Central DuPage Hospital
    Winfield, Illinois 60190, United States
  • Lutheran Medical Group
    Fort Wayne, Indiana 46804, United States
  • Munster Medical Research Foundation
    Munster, Indiana 46321, United States
  • The University of Iowa
    Iowa City, Iowa 52242, United States
  • Baptist Healthcare System Inc. d/b/a Baptist Health Lexington
    Lexington, Kentucky 40503, United States
  • LSU Health Sciences Center at Shreveport
    Shreveport, Louisiana 71103, United States
  • University of Massachusetts
    Worcester, Massachusetts 01655, United States
  • McLaren Health Care Corporation
    Grand Blanc, Michigan 48439, United States
  • Western Michigan University Homer Stryker MD School of Medicine and Bronson Methodist Hospital
    Kalamazoo, Michigan 49008, United States
  • Sparrow Clinical Research Institute
    Lansing, Michigan 48912, United States
  • SSM Health DePaul Hospital
    Bridgeton, Missouri 63044, United States
  • Saint Louis University
    Saint Louis, Missouri 63103, United States
  • The Community Hospital Group Inc. t/a JFK Medical Center
    Edison, New Jersey 08820, United States
  • Rutgers The State University
    Piscataway, New Jersey 08854, United States
  • University of Buffalo
    Buffalo, New York 14203, United States
  • Feinstein Institute for Medical Research, Northwell
    Manhasset, New York 11030, United States
  • ProMedica Toledo Hospital
    Toledo, Ohio 43606, United States
  • Mercy Health St. Vincent Medical Center
    Toledo, Ohio 43608, United States
  • Medical University of South Carolina
    Charleston, South Carolina 29425, United States
  • Texas Tech University of Health Sciences
    El Paso, Texas 79424, United States
  • The University of Texas Health Science Center at Houston
    Houston, Texas 77030, United States
  • Texas Stroke Institute
    Plano, Texas 75075, United States
  • University of Utah
    Salt Lake City, Utah 84112, United States
  • Virginia Commonwealth University
    Richmond, Virginia 23219, United States
  • Valley Medical Center
    Renton, Washington 98055, United States
  • West Virginia University
    Morgantown, West Virginia 26506, United States
  • Aurora Research Institute
    Milwaukee, Wisconsin 53233, United States
07

References and documents

Publications

  • Roaldsen MB, Jusufovic M, Berge E, Lindekleiv H. Endovascular thrombectomy and intra-arterial interventions for acute ischaemic stroke. Cochrane Database Syst Rev. 2021 Jun 14;6(6):CD007574. doi: 10.1002/14651858.CD007574.pub3. PubMed 34125952 ↗

Individual participant data

Plan to share: No — All shared data will be aggregate.

08

Registry details

Key details

Study ID
NCT03805308
Lead sponsor
Mercy Health Ohio
Responsible party
Dr. Osama O. Zaidat (Neuroscience and Stroke Medical Director, Mercy Health Ohio) — Principal investigator
First posted
Jan 15, 2019
Start date
Jul 16, 2019
Primary completion
Feb 25, 2023
Completion
Nov 18, 2023
Last update
Apr 23, 2024

Study contacts

Albert J Yoo, MD, PhD
principal investigator · Texas Stroke Institute
Osama O Zaidat, MD, MS
principal investigator · Mercy Health St. Vincent Medical Center

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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