Tests clot-dissolving drug after successful clot removal in stroke

Trial details

Who runs it

Central Hospital, Nancy, France

Trial code

NCT06768138EU 2023-506935-14-01

Record updated

5 June 2025

Original description

Stroke is a leading cause of disability and mortality worldwide. Despite the clinical benefit of mechanical thrombectomy, 1 out of 2 patients treated are functionally independent at 90 days. Achieving the best possible angiographic reperfusion is a key determinant of clinical outcome in acute ischemic stroke patients with anterior circulation large vessel occlusion. Mechanical thrombectomy is standard treatment for large vessel occlusion stroke patients within 24. In the setting of successful (eTICI ≥2b), adjunct intra-arterial thrombolysis may be a promising therapeutic option allowing recanalization of distal arterial occlusions (not accessible to mechanical devices) and improvement of upstream brain reperfusion by targeting microvascular obstruction.Read full original descriptionShow less

Intra-Arterial Thrombolysis After SUCCESSful Angiographic Recanalization in Acute Large Vessel Occlusion Stroke of the Anterior Circulation: the IA-SUCCESS Multicenter, Randomized Clinical Trial

Stroke is a leading cause of disability and mortality worldwide. Despite the clinical benefit of mechanical thrombectomy, 1 out of 2 patients treated are functionally independent at 90 days. Achieving the best possible angiographic reperfusion is a key determinant of clinical outcome in acute ischemic stroke patients with anterior circulation large vessel occlusion. Mechanical thrombectomy is standard treatment for large vessel occlusion stroke patients within 24. In the setting of successful (eTICI ≥2b), adjunct intra-arterial thrombolysis may be a promising therapeutic option allowing recanalization of distal arterial occlusions (not accessible to mechanical devices) and improvement of upstream brain reperfusion by targeting microvascular obstruction.

The IA-SUCCESS randomized trial aims to assess the clinical and safety of adjunct intra-arterial thrombolysis vs. no adjunct intra-arterial thrombolysis after successful angiographic reperfusion in patients with acute anterior circulation large vessel occlusion stroke.

Inclusion: 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: Participation in another clinical trial within 30 days prior to the inclusion which the experiment may affect the 90-day mRS score; 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; Intracerebral hemorrhage; 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; Woman of childbearing age without effective contraception; Person who do not speak French; More than 5 thrombectomy device; Occlusion or high grade stenosis treated by stenting; Patient expected to be unable to present or be available for 3-month visit follow-up; Person referred in articles L.1121-5, L. 1121-7 and L.1121-8 of the French Public Health Code.

ClinicalTrials.gov NCT06768138 · EU CTIS 2023-506935-14-01