Non-invasive Ultrasound and Hematoma Clearance After Intracerebral Hemorrhage

Официальное название

Study on the Safety and Efficacy of Non-Invasive Transcranial Doppler Ultrasound in Promoting Hematoma Clearance for Intracerebral Hemorrhage

Обзор

Intracerebral hemorrhage (ICH) is one of the stroke subtypes with the highest global rates of disability and mortality, accounting for 15%-20% of all strokes. Currently, there is a lack of evidence-based interventions for ICH, with treatment primarily relying on supportive care. There is an urgent clinical need to explore new strategies and technologies. The investigators hypothesize that for ICH patients, best medical treatment combined with a non-invasive ultrasonic scalpel (ultrasound Doppler flow analyzer) may be superior to best medical treatment alone. The primary objective of this study is to determine the safety and efficacy of the non-invasive ultrasonic scalpel in promoting hematoma clearance in ICH patients.

Подробное описание

This is a multicenter, randomized, double-blind, controlled trial investigating the use of a 2MHz non-invasive ultrasonic scalpel (ultrasound Doppler flow analyzer, registered as Medical System for Ultrasound Diagnosis) in patients with acute ICH. Eligible participants (n=86 will be randomized 1:1 to either the intervention group (ultrasound + standard medical treatment) or the control group (sham ultrasound + standard treatment). The ultrasound intervention involves daily 20-minute sessions for 7 consecutive days. Primary outcomes include hematoma clearance rates and neurological function improvement, assessed via imaging and clinical scales at multiple time points (baseline, 24±12 hours, 72±12 hours, 7±1days/discharge, 3 months). Safety will be monitored through adverse event tracking, vital signs, and neurological examinations. Ethical approval has been obtained, and all participants will provide informed consent.

Вмешательства

• Устройство non-invasive ultrasonic scalpel
  On the basis of best medical management, 2 MHz non-invasive ultrasonic scalpel was used for intervention within 48-72 hours after the occurrence of intracerebral hemorrhage, 20min/ day, and continued for 7 days.
• Устройство Sham Comparator
  On the basis of best medical management, a sham non-invasive ultrasonic scalpel (simulating real treatment with zero energy output) was applied within 48-72 hours after the occurrence of intracerebral hemorrhage, 20 min/day for 7 consecutive days

Первичные конечные точки

• Hematoma clearance rate on CT at Day 7±1day after randomization/discharge； [Срок оценки: Day 7±1day after randomization/discharge]

Вторичные конечные точки (8)

• Hematoma expansion on CT at 24±12 hours after randomization [Срок оценки: 24±12 hours after randomization]
• Neurological improvement at 24±12 hours after randomization (NIHSS(baseline)- NIHSS(24±12 hours)) [Срок оценки: 24±12 hours after randomization]
• Absolute hematoma volume (mL) on CT at 72±12 hours after randomization [Срок оценки: 72±12 hours after randomization]
• Neurological improvement at 72±12 hours after randomization(NIHSS(baseline)- NIHSS(72±12 hours)) [Срок оценки: 72±12 hours after randomization]
• Absolute hematoma volume (mL) on CT at Day 7±1day after randomization/discharge [Срок оценки: Day 7±1 day after randomization or discharge]
• Absolute perihematomal edema (PHE) volume (mL) on CT at Day 7±1day after randomization/discharge [Срок оценки: Day 7±1 day after randomization or discharge]
• Neurological improvement at Day 7±1day after randomization/discharge(NIHSS(baseline)- NIHSS( Day 7±1day)) [Срок оценки: Day7±1day after randomization or discharge]
• Modified Rankin Scale (mRS) score at 90±7 days after onset [Срок оценки: 90±7 days after onset]

Критерии участия

Критерии включения

• Age 18 to 80 years;
• Spontaneous intracerebral hemorrhage (ICH);
• Supratentorial ICH;
• Hematoma volume <30 mL (calculated using the ABC/2 method);
• Glasgow Coma Scale (GCS) score >9 at randomization;
• Time from onset to randomization: 48-72 hours;
• Patient and/or legal representative provides informed consent.

Критерии исключения

• Intracerebral hemorrhage attributed to other causes (e.g., cerebral aneurysm, cerebrovascular malformation, brain tumor, cerebral venous sinus thrombosis, hemorrhagic transformation of ischemic stroke, head trauma, anticoagulation therapy, hematologic disorders).
• Hemorrhage located in the infratentorial region.
• Hemorrhage confined primarily to the ventricular system.
• Clinical signs or symptoms suggestive of brain herniation (e.g., progressive decline in level of consciousness, diminished or absent pupillary light reflexes, bilateral pyramidal signs).
• Severe cardiac dysfunction (NYHA Class III or IV).
• High-risk chronic arrhythmias (e.g., sick sinus syndrome, second- or third-degree atrioventricular block, bradycardia-related syncope without pacemaker implantation).
• Severe hepatic impairment defined as ALT >2x ULN or AST >2x ULN (ULN = Upper Limit of Normal).
• Severe renal impairment defined as serum creatinine >1.5x ULN.
• History of severe asthma or chronic obstructive pulmonary disease (COPD).
• History of coagulopathy or systemic bleeding disorder.
• Leukopenia (<2 × 10⁹/L) or thrombocytopenia (<100 × 10⁹/L).
• Patients scheduled for surgical intervention (including, but not limited to, hematoma evacuation \[minimally invasive or conventional\], decompressive craniectomy, hematoma aspiration, or external ventricular drainage) prior to the first dose of study treatment.
• Pre-stroke modified Rankin Scale (mRS) score >2.
• Presence of other severe disease resulting in a life expectancy of less than 1 year.
• Inability to understand the study procedures and/or complete follow-up due to psychiatric illness, cognitive impairment, or emotional disorders.
• Women who are pregnant or lactating.
• Participation in another clinical trial within the past 3 months or current participation in another clinical trial.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Двойное слепое

Основная цель

Лечение

Центры проведения

Китай · 3 центра

• The First Affiliated Hospital of Wannan Medical University — Wuhu
• Beijing Fengtai You'anmen Hospital — Пекин
• Beijing Tiantan Hospital of Capital Medical University — Пекин

Идентификаторы

NCT: NCT07246473 · CFH-brain2024-2-2051

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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