Trial Review

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Trial registered on ANZCTR


Registration number
ACTRN12622000804785
Ethics application status
Approved
Date submitted
25/03/2022
Date registered
8/06/2022
Date last updated
21/09/2023
Date data sharing statement initially provided
8/06/2022
Type of registration
Prospectively registered

Titles & IDs
Public title
Stroke in patients with large Ischaemic Core: Assessment of Reperfusion therapy Impact on Outcome (SICARIO-LC)
Scientific title
Stroke in patients with large Ischaemic Core: Assessment of Reperfusion therapy Impact on disability Outcomes: SICARIO Phase II randomised controlled trial on thrombectomy vs standard care.
Secondary ID [1] 306612 0
NHMRC MRFF 2020 Cardiovascular Health Mission APP2007317
Universal Trial Number (UTN)
Trial acronym
SICARIO-LC
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Acute Ischaemic stroke 325532 0
Condition category
Condition code
Stroke 322902 322902 0 0
Ischaemic

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
SICARIO-LC will include patients presenting with a baseline perfusion core lesion volume between 70 and 100mL. Patients will be randomized to receive thrombectomy or not. The thrombectomy device and method used will be at the interventionalist's discretion.

The thrombolysis decision will be up to the treating physicians’ decision based on current local/regional best evidence guidelines. This will minimize the chances of selection bias as the research team members are not interfering in the clinician’s judgment. However, the research team will control the thrombolysis decision at the randomisation process to avoid any possible imbalances.

Two types of standard of care clot retrieval devices used. (brands may vary between countries)
1. Stent retrievers such as Trevo by Stryker, Solitaire by Medtronic.
2. Aspiration catheters such as Penumbra

Duration of thrombectomy procedure depends on complexity, approximately 1-2 hours. Procedure to be initiated within 2 hours of presentation as per protocol and carried out by the neurointerventionalist.
Intervention code [1] 323051 0
Treatment: Other
Intervention code [2] 323052 0
Treatment: Surgery
Comparator / control treatment
Patients enrolled into SICARIO-LC with an ischaemic core between 70 - 100mls will be randomised to thrombectomy (intervention) or not (control).
Control group
Active

Outcomes
Primary outcome [1] 330677 0
For SICARIO-LC - The proportion of patients with modified Rankin Scale (mRS) 0-2 (no significant disability) at 3 months.

Timepoint [1] 330677 0
3 months post-randomisation
Secondary outcome [1] 407189 0
SICARIO-LC - Proportion of patients with mRS score 0-3 at 3 months.

Timepoint [1] 407189 0
3 months post randomisation
Secondary outcome [2] 407604 0
SICARIO-LC - Proportion of patients with mRS score 0-4 at 3 months.

Timepoint [2] 407604 0
3 months post randomisation
Secondary outcome [3] 407605 0
SICARIO-LC - Proportion of patients with mRS score 0-2 at 12 months (for those patients enrolled in Australia and New Zealand).
Timepoint [3] 407605 0
3 months & also 12 months post randomisation for participants enrolled in Australia & New Zealand.
Secondary outcome [4] 407606 0
SICARIO-LC - Proportion of patients with mRS score 0-3 at 12 months (for those patients enrolled in Australia and New Zealand).
Timepoint [4] 407606 0
3 months & also 12 months post randomisation for participants enrolled in Australia & New Zealand.
Secondary outcome [5] 407607 0
SICARIO-LC - Proportion of patients with mRS score 0-4 at 12 months (for those patients enrolled in Australia and New Zealand).
Timepoint [5] 407607 0
3 months & also 12 months post randomisation for participants enrolled in Australia & New Zealand..
Secondary outcome [6] 407608 0
SICARIO-LC - mRS scores at 3 months.

Timepoint [6] 407608 0
3 months post randomisation
Secondary outcome [7] 407609 0
SICARIO-LC - quality of life assessed by EQ-5D

Timepoint [7] 407609 0
3 months & also 12 months post randomisation for participants enrolled in Australia & New Zealand..
Secondary outcome [8] 407610 0
SICARIO-LC - overall health assessed by PROMS-10

Timepoint [8] 407610 0
3 months & also 12 months post randomisation for participants enrolled in Australia & New Zealand..

Eligibility
Key inclusion criteria
• Patients presenting with acute hemispheric ischemic stroke with onset (or the time last known to be well) within 24 hours.
• Presence of a baseline ischemic core of 70-100 mL on CT perfusion imaging or diffusion-perfusion MRI processed with automated perfusion volumetric analysis (MIStar - Apollo Medical Imaging specified as the preferred software for the trial aiming to reduce volume estimation variability).
• Patient’s age is 18 years or above
• Premorbid modified Rankin Scale score 0 to 2.
• Presence of a large vessel occlusion on CTA or MRA.
Large vessel occlusion will be defined as a ‘potentially retrievable’ thrombus at one or more of the following sites: intracranial internal carotid (ICA), middle cerebral artery (MCA) first segment (M1) or combination of an extracranial segment of ICA and an intracranial occlusion (terminal ICA or MCA) -tandem occlusion-.
• Onset of acute imaging to groin puncture (in the patients randomized to thrombectomy) under 120 minutes.
Minimum age
18 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
• Intracranial haemorrhage (ICH) or other diagnosis (e.g. tumour) identified by baseline imaging.
• Vertebro-basilar artery occlusion
• Pre-stroke mRS > 2 (indicating significant previous disability)
• Any terminal illness such that patient would not be expected to survive more than 1 year.
• Any condition that, in the judgment of the investigator could impose hazards to the patient if study therapy is initiated or affect the participation of the patient in the study.
• Pregnancy - women of childbearing age with a positive urine pregnancy test.

Study design
Purpose of the study
Treatment
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Central randomisation by computer.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Adaptive Minimum Sufficient Balance randomisation.
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?



Intervention assignment
Parallel
Other design features
Parallel.
Phase
Not Applicable
Type of endpoint/s
Safety/efficacy
Statistical methods / analysis
SICARIO-LC designed to test the effect of endovascular thrombectomy (with or without thrombolysis) on three-month functional outcomes in the population defined by the size of baseline perfusion core lesion volume between 70 and 100mL.

The proportions of participants with positive primary outcome will be used as inputs for the decision to declare either futility or superiority that will be based on the Bayesian decision rules specified in the trial design section.

Recruitment
Recruitment status
Withdrawn
Reason for early stopping/withdrawal
Other reasons/comments
Other reasons
It would be unethical to randomise this patient population when thrombectomy is now the standard procedure.
Date of first participant enrolment
Anticipated
1/07/2022
Actual
Date of last participant enrolment
Anticipated
1/07/2026
Actual
Date of last data collection
Anticipated
1/07/2027
Actual
Sample size
Target
180
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)
NSW,SA,VIC
Recruitment hospital [1] 21883 0
John Hunter Hospital - New Lambton
Recruitment hospital [2] 21884 0
Liverpool Hospital - Liverpool
Recruitment hospital [3] 21885 0
Prince of Wales Hospital - Randwick
Recruitment hospital [4] 21889 0
Royal North Shore Hospital - St Leonards
Recruitment hospital [5] 21890 0
Royal Melbourne Hospital - City campus - Parkville
Recruitment hospital [6] 21891 0
Box Hill Hospital - Box Hill
Recruitment hospital [7] 21892 0
Sunshine Hospital - St Albans
Recruitment hospital [8] 21893 0
Monash Medical Centre - Clayton campus - Clayton
Recruitment hospital [9] 21894 0
The Royal Adelaide Hospital - Adelaide
Recruitment postcode(s) [1] 36967 0
2305 - New Lambton
Recruitment postcode(s) [2] 36968 0
2170 - Liverpool
Recruitment postcode(s) [3] 36969 0
2031 - Randwick
Recruitment postcode(s) [4] 36973 0
2065 - St Leonards
Recruitment postcode(s) [5] 36974 0
3050 - Parkville
Recruitment postcode(s) [6] 36975 0
3128 - Box Hill
Recruitment postcode(s) [7] 36976 0
3021 - St Albans
Recruitment postcode(s) [8] 36977 0
3168 - Clayton
Recruitment postcode(s) [9] 36978 0
5000 - Adelaide
Recruitment outside Australia
Country [1] 24645 0
Spain
State/province [1] 24645 0
Catalunya / Barcelona

Funding & Sponsors
Funding source category [1] 310946 0
Government body
Name [1] 310946 0
National Health Medical Research Council - Medical Research Future Fund
Country [1] 310946 0
Australia
Primary sponsor type
University
Name
The University of Newcastle
Address
University Drive, Callaghan, NSW 2308
Country
Australia
Secondary sponsor category [1] 312247 0
None
Name [1] 312247 0
Address [1] 312247 0
Country [1] 312247 0

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 310505 0
Hunter New England Human Research Ethics Committee
Ethics committee address [1] 310505 0
Ethics committee country [1] 310505 0
Australia
Date submitted for ethics approval [1] 310505 0
30/11/2021
Approval date [1] 310505 0
24/01/2022
Ethics approval number [1] 310505 0
2021/ETH12220

Summary
Brief summary
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 117886 0
Prof Christopher Levi
Address 117886 0
HNELHD Area Headquarters Building
John Hunter Hospital Campus
Locked Bag No. 1 Hunter Region Mail Centre
NSW 2310
Country 117886 0
Australia
Phone 117886 0
+61 2 49 236288
Fax 117886 0
+61 2 49 213488
Email 117886 0
[email protected]
Contact person for public queries
Name 117887 0
Michelle Russell
Address 117887 0
Neurology Department
Level 2, John Hunter Hospital
Locked Bag No.1 Hunter Region Mail Centre
NSW 2310
Country 117887 0
Australia
Phone 117887 0
+61249213481
Fax 117887 0
+61249213488
Email 117887 0
[email protected]
Contact person for scientific queries
Name 117888 0
Christopher Levi
Address 117888 0
HNELHD Area Headquarters Building
John Hunter Hospital Campus
Locked Bag No. 1 Hunter Region Mail Centre
NSW 2310
Country 117888 0
Australia
Phone 117888 0
+61249236288
Fax 117888 0
+61 2 49 213488
Email 117888 0
[email protected]

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
No/undecided IPD sharing reason/comment


What supporting documents are/will be available?

No Supporting Document Provided



Results publications and other study-related documents

Documents added manually
No documents have been uploaded by study researchers.

Documents added automatically
No additional documents have been identified.