Intra-arterial Thrombolysis After Successful Thrombectomy for Acute Ischemic Stroke Due to Large Vessel Occlusion in the Posterior Circulation (IAT-TOP)  

Study started April 2023, Ongoing

ClinicalTrials.gov Identifier: NCT05897554

ClinicalTrials.gov:https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000D9QP&selectaction=Edit&uid=U00053OC&ts=5&cx=h8aimx

The IAT-TOP trial is a government-funded, prospective, multicenter, randomized controlled trial. Patients will be randomized (1:1) to intra-arterial rt-PA group or without intra-arterial rt-PA group. Primary outcome is the rate of modified Rankin Scale score of 0-2 within 90 days after randomization. The IAT-TOP trial will be conducted in 34 sites in China.

Keywords：

Intra-arterial thrombolysis，Alteplase，Large vessel occlusion，Mechanical thrombectomy，Endovascular treatment

Relevant article:

●Adusumilli G, Kobeissi H, et al. Endovascular thrombectomy after acute ischemic stroke of the basilar artery: a meta-analysis of four randomized controlled trials. J Neurointerv Surg. 2023 Dec 21;15(e3):e446-e451. doi: 10.1136/jnis-2022-019776. PMID: 36597942.

●Renú A, Millán M, et al. CHOICE Investigators. Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial. JAMA. 2022 Mar 1;327(9):826-835. doi: 10.1001/jama.2022.1645. PMID: 35143603; PMCID: PMC8832304.

Study started April 2023, Ongoing ClinicalTrials.gov Identifier: NCT05899582 ClinicalTrials.gov: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000D9N3&selectaction=Edit&uid=U00053OC&ts=5&cx=-8ug04h The CMOSS-2 trial is a government-funded, prospective, multicenter, randomized controlled trial. It will recruit symptomatic chronic occlusion of the middle cerebral artery in patients with severe hemodynamic insufficiency. Only high-volume center with a proven track record will be included. Patients will be randomized (1:1) to best medical treatment alone or medical treatment plus bypass surgery. Primary outcome is ischemic stroke in the territory of the target artery within 24 months after randomization. The CMOSS-2 trial will be conducted in 13 sites in China. Keywords: Middle cerebral artery occlusion, stroke，TIA Relevant article: ●Ma Y, Wang T, et al. CMOSS Investigators. Extracranial-Intracranial Bypass and Risk of Stroke and Death in Patients With Symptomatic Artery Occlusion: The CMOSS Randomized Clinical Trial. JAMA. 2023 Aug 22;330(8):704-714. doi: 10.1001/jama.2023.13390. PMID: 37606672; PMCID: PMC10445185.

●Gao P, Wang T, et aal. CASSISS Trial Investigators. Effect of Stenting Plus Medical Therapy vs Medical Therapy Alone on Risk of Stroke and Death in Patients With Symptomatic Intracranial Stenosis: The CASSISS Randomized Clinical Trial. JAMA. 2022 Aug 9;328(6):534-542. doi: 10.1001/jama.2022.12000IF: 120.7 Q1 . PMID: 35943472; PMCID: PMC9364128. ●Powers WJ, Clarke WR, et al. COSS Investigators. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA. 2011 Nov 9;306(18):1983-92. doi: 10.1001/jama.2011.1610. Erratum in: JAMA. 2011 Dec 28;306(24):2672. Obviagele, Bruce [corrected to Ovbiagele, Bruce]. PMID: 22068990; PMCID: PMC3601825.

The Carotid and Middle Cerebral Artery Occlusion Surgery Study (CMOSS)

China Angioplasty and Stenting for Symptomatic Intracranial Severe Stenosis (CASSISS)

Study started November 2013, Completion December 2015 ClinicalTrials.gov Identifier: NCT01994161 https://clinicaltrials.gov/ct2/show/NCT01994161?term=NCT01994161&draw=2&rank=1

The study is designed to observe the safety and effectiveness of intracranial stenting for preventing stroke during a mean follow-up of 3 years in patients with symptomatic stenosis of a major intracranial artery (MCA, carotid, vertebral, basilar).

CRITICAS is a prospective, government-funded registration study. The CRITICAS will explore the incidence rate of ischemic stroke, death or cardiovascular events after enrollment or any revascularization procedure of the qualifying lesion in the territory of the symptomatic intracranial artery.