Imaging to detect impaired microcirculatory reperfusion after clot removal
Image Detection of Impaired Microcirculatory Reperfusion
This project tests whether CT perfusion scans done after clot removal can spot poor tiny-vessel blood flow in adults with large-vessel ischemic stroke.
Quick facts
| Study type | Observational |
|---|---|
| Enrollment | 40 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | University of Cincinnati Academic / other |
| Locations | 1 site (Cincinnati, Ohio) |
| Trial ID | NCT07099599 on ClinicalTrials.gov |
What this trial studies
ID IMR is a single-center, prospective feasibility observational effort using post-thrombectomy CT perfusion to find a radiographic biomarker of impaired microcirculatory reperfusion (IMR) after angiographic reperfusion. The study enrolls adults with anterior-circulation large-vessel occlusion who achieve near-complete or complete reperfusion (mTICI 2c/3) following mechanical thrombectomy within 24 hours of last known normal. Investigators analyze CT perfusion patterns and related clinical variables to identify imaging features that predict infarct expansion despite successful vessel opening. The best-performing imaging biomarker from this cohort will be validated in a larger prospective study as a surrogate marker of IMR.
Who should consider this trial
Good fit: Adults (≥18 years) with anterior-circulation large-vessel occlusion treated with mechanical thrombectomy who achieve mTICI 2c/3 reperfusion within 24 hours of last known normal and who can undergo contrast CT perfusion are the ideal candidates.
Not a fit: Patients with severe renal insufficiency, contraindications to iodinated contrast or MRI, tandem occlusions, prior significant ipsilateral stroke, more than four clot retrieval attempts, pregnancy, incarceration, or enrollment in other acute interventional stroke trials are unlikely to qualify or benefit.
Why it matters
Potential benefit: If successful, this could let clinicians identify patients who remain at high risk of brain tissue damage despite successful clot removal and target them for additional treatments or closer monitoring.
How similar studies have performed: Microvascular 'no-reflow' after thrombectomy is a recognized phenomenon and small imaging studies have suggested patterns on perfusion scans, but a validated radiographic biomarker for IMR remains novel and unproven.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Adults greater than or equal to 18 years of age * Last known normal (LKN) within 24 hours * Ischemic stroke due to anterior circulation LVO (intracranial internal carotid artery \[ICA\], proximal middle cerebral artery \[M1\], M1/M2 bifurcation, or proximal dominant M2 occlusion) * mTICI2c or mTICI3 on digital subtracted angiography (DSA) following mechanical thrombectomy Exclusion Criteria: * Significant renal insufficiency (glomerular filtration rate \<30mg/ml/min2 while not on dialysis) * Contraindication to iodinated contrast * Contraindication to magnetic resonance imaging (e.g., pacemaker incompatibility) * Prior significant stroke in same vascular territory ipsilateral stroke * Tandem vessel occlusion (i.e., extracranial ICA and ipsilateral intracranial M1/M2 occlusion) * Greater than 4 clot retrieval attempts * Enrollment in another acute stroke interventional study (with the exception of thrombectomy device registries) * Pregnancy * Prisoners
Where this trial is running
Cincinnati, Ohio
- University of Cincinnati — Cincinnati, Ohio, United States (Recruiting)
Study contacts
- Study coordinator: Yasmin N Aziz, MD
- Email: azizyn@ucmail.uc.edu
- Phone: 513-688-5405
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.