- ICH GCP
- US-Register für klinische Studien
- Klinische Studie NCT02118233
Cognitive Outcome After Carotid Surgery
Studienübersicht
Status
Bedingungen
Detaillierte Beschreibung
At the present time, large multi-center clinical trials support the use of carotid revascularization for symptomatic carotid stenosis and for asymptomatic carotid stenosis (greater than 60%) to prevent stroke. Guidelines supporting the use of carotid endarterectomy for asymptomatic stenosis are based largely on the Asymptomatic Carotid Atherosclerosis Study (ACAS) which reported a 47% relative risk reduction for ipsilateral stroke or death in patients randomized to surgery compared to best medical management over 5 years. These data were further substantiated by the recent publication of the Medical Research Council Asymptomatic Carotid Surgery (ACST) trial results (1); however, both trials estimated that at least 40 operative procedures were required to prevent a single disabling stroke or death in one patient after 5 years (2). These data underscore the importance of understanding the cognitive risks of carotid revascularization and developing strategies to limit factors that contribute to this risk especially in asymptomatic patients.
The purpose of this study is to better understand the effect of carotid revascularization (using either carotid endarterectomy (CEA) or percutaneous carotid angioplasty and stenting (CAS)) on cognitive outcome by prospectively collecting cerebral blood flow data and cognitive testing data prior to and after carotid revascularization procedures.
Studientyp
Einschreibung (Voraussichtlich)
Kontakte und Standorte
Studienorte
-
-
Massachusetts
-
Burlington, Massachusetts, Vereinigte Staaten, 01805
- Lahey Clinic, Inc.
-
-
New York
-
Buffalo, New York, Vereinigte Staaten, 14203
- University of Buffalo Neurosurgery (UBNS)
-
Stony Brook, New York, Vereinigte Staaten, 11794-8122
- StonyBrook
-
-
Teilnahmekriterien
Zulassungskriterien
Studienberechtigtes Alter
Akzeptiert gesunde Freiwillige
Studienberechtigte Geschlechter
Probenahmeverfahren
Studienpopulation
Beschreibung
Inclusion Criteria:
- Patients with asymptomatic (defined as no symptoms in past 6 months) carotid stenosis
- Patients with hemodynamically significant carotid artery stenosis (according to CREST criteria: ≥ 60% by angiography, OR ≥ 70% by ultrasound, OR ≥ 80% by CTA or MRA)
Exclusion Criteria:
- Patients with prior large vessel infarct
- Patients with intracranial stenosis
- Patients with major depression
- Patients with Alzheimer disease (clinically defined or Wechsler IQ <80)
- Patients who have had previous ipsilateral carotid surgery
- Patients with baseline dementia defined as: Mini-Mental Status Examination score < 21 OR Mini-Mental score ≥21 AND Baseline HVLT scores more than 3 standard deviations below normal or FAS scores more than 2 standard deviations below normal OR other clinical symptoms that were not as evident on direct cognitive assessment (e.g. sundowning, getting lost while driving).
Note: A control group would be comprised of about 15 patients who meet eligibility criteria as above, but elect to have their condition followed rather than undergo revascularization.
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
Kohorten und Interventionen
Gruppe / Kohorte |
---|
Carotid Endarterectomy (CEA)
Surgical Revascularization- Carotid Endarterectomy (CEA)
|
Carotid Angioplasty and Stenting (CAS)
Surgical Revascularization- Carotid Angioplasty and Stenting (CAS)
|
Control Group- Medical Management
|
Was misst die Studie?
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
---|---|---|
Measurement of change in cerebral blood flow from pre-op/baseline to 1 month post-operatively.
Zeitfenster: preoperative/baseline and 1 month postoperative/from baseline
|
Quantitative flow MRA studies will be performed pre-operative and postoperative for those undergoing carotid revascularization surgery.
Those not undergoing surgery will have this test upon study enrollment and approximately 1 month from study enrollment date.
|
preoperative/baseline and 1 month postoperative/from baseline
|
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
---|---|---|
Mini Mental Status Exam
Zeitfenster: Pre-operative/baseline
|
A standardized cognitive measure
|
Pre-operative/baseline
|
Trail Making- Part A
Zeitfenster: Preoperative/baseline, 1 month postoperative/post baseline, 6 months postoperative/post baseline, and 1 year postoperative/post baseline
|
Standardized cognitive measure that assesses verbal fluency
|
Preoperative/baseline, 1 month postoperative/post baseline, 6 months postoperative/post baseline, and 1 year postoperative/post baseline
|
Trail Making- Part B
Zeitfenster: Preoperative/baseline, 1 month postoperative/post baseline, 6 months postoperative/post baseline, and 1 year postoperative/post baseline
|
Standardized cognitive measure that assesses executive functioning
|
Preoperative/baseline, 1 month postoperative/post baseline, 6 months postoperative/post baseline, and 1 year postoperative/post baseline
|
Hopkins Verbal Learning Test (HVLT)
Zeitfenster: Preoperative/baseline, 1 month postoperative/post baseline, 6 months postoperative/post baseline, and 1 year postoperative/post baseline
|
Standardized measure to assess new learning and memory
|
Preoperative/baseline, 1 month postoperative/post baseline, 6 months postoperative/post baseline, and 1 year postoperative/post baseline
|
D-KEFS Verbal Fluency Test (FAS)
Zeitfenster: Preoperative/baseline, 1 month postoperative/post baseline, 6 months postoperative/post baseline, and 1 year postoperative/post baseline
|
Standardized measure to assess letter fluency
|
Preoperative/baseline, 1 month postoperative/post baseline, 6 months postoperative/post baseline, and 1 year postoperative/post baseline
|
Mitarbeiter und Ermittler
Sponsor
Ermittler
- Hauptermittler: Zoher Ghogawala, MD, Lahey Clinic, Inc.
Publikationen und hilfreiche Links
Allgemeine Veröffentlichungen
- Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, Thomas D; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. 2004 May 8;363(9420):1491-502. doi: 10.1016/S0140-6736(04)16146-1. Erratum In: Lancet. 2004 Jul 31;364(9432):416.
- Rothwell PM, Goldstein LB. Carotid endarterectomy for asymptomatic carotid stenosis: asymptomatic carotid surgery trial. Stroke. 2004 Oct;35(10):2425-7. doi: 10.1161/01.STR.0000141706.50170.a7. Epub 2004 Aug 26. No abstract available.
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn
Primärer Abschluss (Tatsächlich)
Studienabschluss (Tatsächlich)
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Schätzen)
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Zusätzliche relevante MeSH-Bedingungen
Andere Studien-ID-Nummern
- 2013-009
Diese Informationen wurden ohne Änderungen direkt von der Website clinicaltrials.gov abgerufen. Wenn Sie Ihre Studiendaten ändern, entfernen oder aktualisieren möchten, wenden Sie sich bitte an register@clinicaltrials.gov. Sobald eine Änderung auf clinicaltrials.gov implementiert wird, wird diese automatisch auch auf unserer Website aktualisiert .