Purpose

This is a multicenter, randomized, adaptive clinical trial comparing standard medical management to early (<24 hours) surgical hematoma evacuation using minimally invasive parafascicular surgery (MIPS) in the treatment of acute spontaneous supratentorial intracerebral hemorrhage.

Conditions

Eligibility

Eligible Ages
Between 18 Years and 80 Years
Eligible Genders
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  • Age 18-80 years
  • Pre-randomization head CT demonstrating an acute, spontaneous, primary ICH
  • Manual ICH volume between 30 - 80 mL
  • Study intervention can reasonably be initiated within 24 hours after the onset of stroke symptoms. If the actual time of onset is unclear, then the onset will be considered the time that the subject was last known to be well
  • Glasgow Coma Score (GCS) 5 - 14
  • Historical Modified Rankin Score 0 or 1

Exclusion Criteria

  • Ruptured aneurysm, arteriovenous malformation (AVM), vascular anomaly, Moyamoya disease, venous sinus thrombosis, mass or tumor, hemorrhagic conversion of an ischemic infarct, recurrence of a recent (<1 year) ICH, as diagnosed with radiographic imaging
  • NIHSS < 5
  • Bilateral fixed dilated pupils
  • Extensor motor posturing
  • Intraventricular extension of the hemorrhage is visually estimated to involve >50% of either of the lateral ventricles
  • Primary Thalamic ICH
  • Infratentorial intraparenchymal hemorrhage including midbrain, pontine, or cerebellar
  • Use of anticoagulants that cannot be rapidly reversed
  • Evidence of active bleeding involving a retroperitoneal, gastrointestinal, genitourinary, or respiratory tract site
  • Uncorrected coagulopathy or known clotting disorder
  • Platelet count < 75,000, International Normalized Ratio (INR) > 1.4 after correction
  • Patients requiring long-term anti-coagulation that needs to be initiated < 5 days from index ICH
  • End stage renal disease
  • Patients with a mechanical heart valve
  • End-stage liver disease
  • History of drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements
  • Positive urine or serum pregnancy test in female subjects without documented history of surgical sterilization or is post-menopausal
  • Known life-expectancy of less than 6 months
  • No reasonable expectation of recovery, Do-Not-Resuscitate (DNR), or comfort measures only prior to randomization
  • Participation in a concurrent interventional medical investigation or clinical trial.
  • Inability or unwillingness of subject or legal guardian/representative to give written informed consent
  • Homelessness or inability to meet follow up requirements

Study Design

Phase
N/A
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Treatment
Masking
Single (Outcomes Assessor)

Arm Groups

ArmDescriptionAssigned Intervention
Experimental
Early Surgical Hematoma Evacuation
Subjects will receive early surgical hematoma evacuation using Minimally Invasive Parafascicular Surgery (MIPS).
  • Procedure: Early Surgical Hematoma Evacuation
    Early Minimally Invasive Parafascicular Surgery (MIPS)
No Intervention
Medical Management
Subjects will receive standard of care medical management for ICH.

Recruiting Locations

University of Alabama at Birmingham
Birmingham, Alabama 35294

University of Arkansas for Medical Sciences
Little Rock, Arkansas 72205

University of Southern California (USC)
Los Angeles, California 90033

Delray Medical Center
Delray Beach, Florida 33484

Mayo Clinic
Jacksonville, Florida 32224
Contact:
Kaisorn Chaichana, MD

University of Miami / Jackson Memorial Hospital
Miami, Florida 33136

Emory University School of Medicine
Atlanta, Georgia 30303
Contact:
877-572-5511
ENRICH@emory.edu

Rush University Medical Center
Chicago, Illinois 60612

NorthShore University Health System
Evanston, Illinois 60201

OSF Saint Francis Medical Center
Peoria, Illinois 61637

Indiana University
Indianapolis, Indiana 46202

Johns Hopkins University
Baltimore, Maryland 21287

Brigham and Women's Hospital
Boston, Massachusetts 02115

Spectrum Health
Grand Rapids, Michigan 49503

Saint Louis University
Saint Louis, Missouri 63110

Washington University (Barnes Jewish)
Saint Louis, Missouri 63110

Albany Medical Center
Albany, New York 12208

State University of New York, Buffalo
Buffalo, New York 14203

New York Presbyterian Queens
Flushing, New York 11355

Weill Cornell Medicine
New York, New York 10021

The University of North Carolina at Chapel Hill
Chapel Hill, North Carolina 27599

Cleveland Clinic Foundation
Cleveland, Ohio 44195

Ohio State University Wexner Medical Center
Columbus, Ohio 43210
Contact:
Patrick Youssef, MD

OhioHealth Riverside Methodist Hospital
Columbus, Ohio 43214

University of Oklahoma
Oklahoma City, Oklahoma 73104

Geisinger Health System
Danville, Pennsylvania 17821

Penn State Hershey Medical Center
Hershey, Pennsylvania 17033

Allegheny General Hospital
Pittsburgh, Pennsylvania 15212

University of Pittsburgh Medical Center (UPMC)
Pittsburgh, Pennsylvania 15213

Vanderbilt University Medical Center
Nashville, Tennessee 37232

More Details

NCT ID
NCT02880878
Status
Recruiting
Sponsor
Nico Corporation

Study Contact

Penny Sekerak, MBA, BA, RN
317-660-7118
Penny.Sekerak@niconeuro.com

Detailed Description

The ENRICH trial will compare the outcomes between early surgical intervention using the BrainPath® Approach (i.e., MIPS) and a medically managed cohort. The integrated surgical approach includes a combination of available technologies, including the FDA-cleared NICO BrainPath® for non-disruptive access and NICO Myriad® to achieve the goal of maximum clot evacuation. The medically managed cohort will be treated according the Clinical Standardization Guidelines (CSG) as adapted by Emory University from the 2015 AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage. Clinical efficacy will be determined by demonstrating a 10% improvement in functional outcome, as determined by a blinded-assessment of the 180-day utility-weighted modified Rankin Scale (mRS).

Data suggests improved mortality rates and potential functional benefits of surgical ICH evacuation. The methodology proposed for this trial was tested in a preliminary series of 39 patients treated for supratentorial spontaneous ICH and retrospectively reviewed (Labib et al.). These results were replicated in a single center retrospective series of 18 patients (Bauer et al.). Despite positive results of both studies and the widely accepted benefit of the BrainPath Approach (i.e., MIPS) for subcortical lesions, stronger evidence supporting the use of these techniques in ICH is needed for the technique to become universally validated.

Notice

Study information shown on this site is derived from ClinicalTrials.gov (a public registry operated by the National Institutes of Health). The listing of studies provided is not certain to be all studies for which you might be eligible. Furthermore, study eligibility requirements can be difficult to understand and may change over time, so it is wise to speak with your medical care provider and individual research study teams when making decisions related to participation.