Intra-arterial alteplase after successful reperfusion for anterior circulation ischemic stroke

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

IA-SUCCESS is a prospective phase 3, multicenter, randomized open-label trial with blinded endpoint assessment comparing adjunct intra-arterial alteplase versus no adjunct therapy after angiographic reperfusion (eTICI 2b-2c-3) in anterior circulation large vessel occlusion stroke. Eligible patients are randomized in the angiosuite after initial reperfusion achieved by intravenous thrombolysis, bridging therapy, or mechanical thrombectomy. The experimental arm receives intra-arterial alteplase 0.225 mg/kg (maximum 20 mg) infused through a guiding catheter in the internal carotid artery over 15 minutes, and the primary outcome is a shift toward better 90-day modified Rankin Scale scores; health-economic and budget-impact analyses are included as secondary objectives. Safety monitoring focuses on hemorrhagic complications and other procedure-related adverse events.

Why it matters

Who can join: the full rules

Inclusion Criteria:

* Age ≥ 18 years
* Pre-stroke mRS 0-2
* Acute ischemic stroke with anterior circulation large vessel occlusion defined as intracranial internal carotid artery, M1, or M2 occlusion proven on CT or MRI
* NIHSS score ≥ 5 at admission
* Acute reperfusion strategy started within 24h after stroke onset according to the international guidelines
* DWI-ASPECTS ≥ 2 (MRI) or CT-ASPECTS ≥ 3
* Delay from imaging to puncture within 3 hours for transferred patients
* eTICI 2b-2c-3 after intravenous thrombolysis alone, bridging therapy, or mechanical thrombectomy alone and confirmed by catheter angiogram
* Person affiliated to or beneficiary of a social security plan

Exclusion Criteria:

* Person who do not speak French
* Contraindications for intra-arterial thrombolysis: Platelet count \<100 000/mm3, INR \>1.7, AOD use \<48h or biological confirmation of activity and effective heparin treatment
* Bleeding-risk complications during the mechanical thrombectomy procedure (e.g carotid dissection, complicated femoral approach)
* Bleeding-risk complications consecutive to a fall associated with stroke
* More than 5 thrombectomy device
* Intracerebral hemorrhage
* Occlusion or high grade stenosis treated by stenting
* Patient expected to be unable to present or be available for 3-month visit follow-up
* Participation in another clinical trial within 30 days prior to the inclusion which the experiment may affect the 90-day mRS score
* Woman of childbearing age without effective contraception
* Person referred in articles L.1121-5, L. 1121-7 and L.1121-8 of the French Public Health Code

Where it's running

• CHRU Nancy
  Nancy, France Recruiting

Study contacts

• Study coordinator: Benjamin GORY, MD, PHD
• Email: b.gory@chru-nancy.fr
• Phone: +33 3 83 85 15 01

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Other studies for the same condition or treatment. Recruiting studies are listed first.

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.