Glenzocimab for REperfusion in the Setting of Endovascular Therapy for Brain infarctioN: GREEN Study

Prior treatment

• Patients previously treated by tenecteplase within 24 hrs;
• Gastrointestinal or urinary tract hemorrhage in previous 21 days;
• Participation in another interventional clinical trial within 30 days prior to the inclusion.
• patients receiving anticoagulants, as already mentioned in the non-authorized concomitant treatments
• patients who have already received another humanized fragment of monoclonal antibody with a suspicion of hypersensitivity

Other illness

• Pre-existing neurologic and psychiatric disease with mRS ≥ 3;
• Patient with intracranial haemorrhage
• Known hypersensitivity to glenzocimab or to any of the excipients;
• Severe renal insufficiency (Grades 4-5) with a glomerular filtration rate \< 30mL/Min/1.73m2;
• Persons deprived of their liberty by a judicial or administrative decision, persons subject to psychiatric care under sections L.3212-1 et L.3213-1 and persons admitted to a health or social institution for purposes other than research (L.1121-6)

Lab values

• Platelet count \<100 000 mm3;

Other

• Contraindications to EVT;
• Contraindication to contrast agents
• Unknown symptom's onset;
• Patients under or needing immediate DAPT administration;
• Significant mass effect with midline shift as confirmed on CT/MRI;
• Pregnant or breastfeeding woman;
• Adults subject to a legal protection measure (L.1121-8)
• The patient or his/her family (if the patient is unable to give his/her opinion) expresses an inability to return for protocol visits

• Age 18 years or older (Age≥18 years)
• No significant pre-stroke disability (pre-stroke mRS must be equal to 0 or 1);
• Indication of EVT within the time-window of 0 to 24 hrs in participants treated with or without intravenous thrombolysis;
• Participants presenting with a target mismatch defined by an initial infarct volume (ischemic core) of less than 70 ml, a ratio of volume of ischemic tissue to initial infarct volume of 1.8 or more, and an absolute volume of potentially reversible ischemia (penumbra) of 15 ml or more on magnetic resonance imaging (MRI) or, when this is not possible, on perfusion computed tomography (CTP);
• Occlusion of the cervical or intracranial internal carotid artery (ICA) or the proximal middle cerebral artery (MCA - M1 and M2), on magnetic resonance angiography (MRA) or, when this is not possible, on CT angiography (CTA);
• Informed consent signed:
  • By the patient
  • Or informed consent signed by a family members/trustworthy person if his condition does not allow him to express his consent by written as per L. 1111-6,
  • In a situation urgently and in the absence of family members/trustworthy person, the patient can be enrolled. The consent to participate to the research will be requested as soon as the condition of the patient will allow him to consent.
• Post-menopausal women defined as not having menses for 12 months without an alternative medical cause. For WOCBP, a highly effective birth control method should be in place that can achieve a failure rate of less than 1% per year that should last for at least 2 months after IMP administration.
  • Birth control methods which may be considered as highly effective in WOCBP include:
  • combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (intravaginal, transdermal),
  • progestogen-only hormonal contraception associated with inhibition of ovulation (injectable, implantable)
  • intrauterine device (IUD),
  • intrauterine hormone-releasing system (IUS),
  • bilateral tubal occlusion,
  • vasectomized partner,
  • Birth control methods which may be considered as highly effective for men and that should last for 4 months after IMP administration include:
  • vasectomy,
  • use of condom combined with a highly effective birth control method for their WOCB partner.
  • Please note that hormonal contraception is a risk factor for thromboembolic events and attention should be called to reconsider it passed the acute stroke phase.
• Women of child-bearing potential must have negative results of a plasma pregnancy test (serum betaHCG).
• Affiliation to social security or any health insurance