Rescue Distal Thrombectomy in Treatment for Persistent Distal Occlusions

Condition(s) studied

Investigational drug(s) / intervention(s)

Proximal mechanical thrombectomy: Mechanical thrombectomy performed for the qualifying proximal large vessel occlusion before assessment of eligibility for randomization.

Rescue distal mechanical thrombectomy: Rescue distal mechanical thrombectomy performed during the same endovascular session after successful proximal recanalization to treat persistent distal medium-vessel occlusion identified on angiography.

Conservative management: No additional distal endovascular intervention after successful proximal mechanical thrombectomy. Participants continue with standard medical and post-procedural care.

Study summary

The goal of this clinical trial is to determine whether rescue distal mechanical thrombectomy can improve outcomes in patients with persistent distal occlusions after successful proximal mechanical thrombectomy for acute ischemic stroke.

Many patients with acute ischemic stroke caused by large vessel occlusion undergo emergency treatment with proximal mechanical thrombectomy, which removes the main clot and restores flow in a large artery. However, in some patients, one or more smaller distal arteries remain occluded after successful proximal recanalization. It is not yet known whether treating these persistent distal occlusions improves angiographic or clinical outcomes.

This study will compare two approaches:

Rescue distal mechanical thrombectomy: an additional distal mechanical thrombectomy procedure is performed during the same endovascular session.

Conservative management: no additional distal endovascular intervention is performed after successful proximal mechanical thrombectomy.

The main questions the study aims to answer are:

* Is rescue distal mechanical thrombectomy feasible in this setting?
* Is it safe?
* Does it improve angiographic and clinical outcomes?

Participants will be randomly assigned during the index endovascular procedure to one of the two study groups and will be followed with imaging and clinical assessments during hospitalization and at 90 days.

Approximately 72 participants will take part in this study at the Centre hospitalier de l'Université de Montréal (CHUM).

Eligibility

Primary outcome measure(s)

• Number of participants successfully randomized among screen-eligible participants — Periprocedural
  Number of screen-eligible participants who are successfully randomized during the index endovascular procedure.

Trial sites (1)

More Centre hospitalier de l'Université de Montréal (CHUM) trials in Canada

Other trials for the same condition