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| Name | Class |
|---|---|
| Berlin Institute of Health | OTHER |
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The primary goal of the TCD-REDUCE study is to demonstrate the effectiveness of continuous transcranial Doppler sonography ("sonolysis") on the reduction of the ischemic stroke volume during MitraClip implantation.
Cardiac procedures are associated with new cerebral ischemic lesions detected on diffusion-weighted MRI (Bendszus et al., 2006).
A previous study suggests that sonolysis (continuous transcranial Doppler sonography using a 2-MHz diagnostic probe) can reduce the risk of new cerebral ischemic lesions during carotid endarterectomy and carotid angioplasty / stenting (Skoloudik et al., 2015).
Currently, it is unknown whether sonolysis can also reduce the risk of new cerebral ischemic lesions during MitraClip implantation - a percutaneous treatment option in patients with moderate / severe mitral regurgitation.
In this study, patients will receive cerebral MRI and clinical neurological / neuropsychological examination before and after MitraClip implantation. During MitraClip implantation, all patients will receive continuous transcranial Doppler sonography using a 2-MHz diagnostic probe with maximal diagnostic energy administered through either the left or the right transtemporal window (computer-generated 1:1 randomization).
The primary endpoint is the median ischemic lesion volume detected on diffusion-weighted MRI after MitraClip implantation in the sonolysis group and in the control group.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Sonolysis group | Experimental | Cerebral hemisphere with sonolysis during MitraClip implantation. |
|
| Control group | No Intervention | Cerebral hemisphere without sonolysis during MitraClip implantation. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Sonolysis | Procedure | Continuous transcranial Doppler sonography (TCD) using a 2-MHz diagnostic probe with maximal diagnostic energy |
|
| Measure | Description | Time Frame |
|---|---|---|
| stroke volume | median volume (in ml) of new ischemic lesions detected on diffusion-weighted MRI after MitraClip implantation in the sonolysis and in the control group | 0-5 days after the MitraClip Implantation |
| Measure | Description | Time Frame |
|---|---|---|
| diffusion-weighted MRI lesions | new ischemic lesions (occurrence, number and location) detected on diffusion-weighted MRI after MitraClip implantation | 0-5 days after the MitraClip Implantation |
| intracerebral hemorrhage (ICH) and / or subarachnoid hemorrhage (SAH) |
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Inclusion Criteria:
Patients with mitral regurgitation that are assigned to the MitraClip implantation by an interdisciplinary heart team according to current guidelines.
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Tim Bastian Braemswig, MD | Contact | +49 30 450560624 | tim-bastian.braemswig@charite.de |
| Name | Affiliation | Role |
|---|---|---|
| Christian H Nolte, Prof. | Charite University, Berlin, Germany | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Charité-Campus Benjamin Franklin | Recruiting | Berlin | 12200 | Germany |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26417059 | Background | Skoloudik D, Kuliha M, Hrbac T, Jonszta T, Herzig R; SONOBUSTER Trial Group. Sonolysis in Prevention of Brain Infarction During Carotid Endarterectomy and Stenting (SONOBUSTER): a randomized, controlled trial. Eur Heart J. 2016 Oct 21;37(40):3096-3102. doi: 10.1093/eurheartj/ehv492. Epub 2015 Sep 28. |
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| ID | Term |
|---|---|
| D008944 | Mitral Valve Insufficiency |
| D020521 | Stroke |
| ID | Term |
|---|---|
| D006349 | Heart Valve Diseases |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D002561 | Cerebrovascular Disorders |
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PROBE
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new ICH and / or SAH detected on T2*-weighted MRI after MitraClip implantation |
| 0-5 days after the MitraClip Implantation |
| cerebral microbleeds (CMB) | new cerebral microbleeds detected on T2*-weighted MRI after MitraClip implantation (occurrence, number and location) | 0-5 days after the MitraClip Implantation |
| clinically overt stroke | new clinically overt stroke (ischemic or hemorrhagic) or transient ischemic attack (TIA) after MitraClip implantation | (1) 0-5 days after the MitraClip Implantation and (2) 3 months after MitraClip implantation |
| functional outcome | functional outcome will be evaluated using the modified Rankin scale (mRS). The mRS ranges from 0 to 6 with 0 indicating no functional deficit (best score) and 6 indicating deaths (worst score). | (1) 0-5 days after the MitraClip Implantation and (2) 3 months after MitraClip implantation |
| cognitive outcome during hospital stay | cognitive outcome will be evaluated using the Montreal Cognitive Assessment (MoCA) | 0-5 days after the MitraClip Implantation |
| cognitive outcome at follow-up | cognitive outcome will be evaluated using the Telephone Interview for Cognitive Status (TICS) | 3 months after MitraClip implantation |
| delirium | delirium will be evaluated using the 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) | 0-5 days after the MitraClip Implantation |
| length of hospital stay (duration of hospitalization for the MitraClip implantation) | days of hospital stay from admission to hospital to discharge from hospital including direction of discharge (home, another hospital) | length of hospital stay (up to 3 months after MitraClip implantation) |
| mortality | mortality | up to 3 months after MitraClip implantation |
| D001927 |
| Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D014652 | Vascular Diseases |