Carotid Endarterectomy and Carotid Artery Stenting in Brazil

NCT ID: NCT02538276

Last Updated: 2017-05-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

500 participants

Study Classification

OBSERVATIONAL

Study Start Date

2013-07-31

Study Completion Date

2019-07-31

Brief Summary

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Cerebrovascular disease is a leading cause of death and the leading cause of serious long-term disability. Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are alternative strategies for stroke prevention in patients with atherosclerotic carotid disease.The safety and efficacy of CAS compared to CEA still remains questioned, and CEA has been considered to the first-line treatment of carotid stenosis in worldwide. The purpose of this study is to compare the practice and outcomes of CAS and CEA in a real world setting at Public University Hospitals in Brazil.

Detailed Description

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This study will be a prospective analysis of the treatment of patients with carotid stenosis through carotid endarterectomy and carotid artery stenting performed at 5 centers proposed by five years with the Vascular Study Group from public Universities of Sao Paulo state in Brazil. The primary outcome measures will be:

1. any in-hospital stroke.
2. any stroke, death, or myocardial infarction (MI). Patients undergoing CEA in conjunction with cardiac surgery will be excluded. Multivariate logistic regression will be performed to identify predictors of stroke or death in patients undergoing CEA and CAS.

The characteristics and background of patients who underwent CAS and CEA include: age, gender, carotid endarterectomy high risk; also presentation of symptoms, and degree of stenosis will be analyzed. Next, procedural success, periprocedural antiplatelet use, embolic protection device use, the type of stent (open-cell or closed-cell) or patch to carotid, the execution of pre ballooning or post ballooning dilatation at carotid artery stenting, and procedure-related complications will be analyzed to clarify the current strategy and the treatment results of both techniques . Degree of stenosis have been measured in accordance with North American Symptomatic Carotid Endarterectomy Trial method.

Outcomes will be stratified by symptomatic and asymptomatic status. Symptomatic patients are defined as having a neurologic event, including any hemispheric or ocular transient ischemic attack,major or minor stroke preceding the intervention ipsilateral to the treated lesion. Technical success relates to periprocedural events that occur from the initiation of the procedure and extend through the first 24-hour postoperative period. Primary technical success was defined on an intent-to-treat basis, and it will requires the successful exclusion of the carotid plaque by surgical or interventional means. Technical success include the outcomes and complications of preoperative carotid angiograms whenever these imaging studies are obtained prior to the carotid intervention. For carotid endarterectomy, primary technical success implies a successful removal of the carotid plaque and closure of the artery with or without patch and less than a 30% residual stenosis. For carotid stenting, the introduction and deployment of the embolic protection device and the carotid stent in the absence of stroke, myocardial infarction, death, surgical conversion, or vascular obstruction constitutes primary technical success.

All complications should be categorized as local vascular, local nonvascular, and systemic. Other complications. As with any vascular procedures, complications after carotid interventions should be reported in a systematic and standardized manner with a description of the degrees of severity. Although assigning a degree of severity to all complications of different methods of treatment may be difficult, severity scales should be provided whenever possible so adverse events can be assessed and compared. The following severity scale has been modified from the reporting standards for lower extremity ischemia:Mild (1) refers to a complication that resolves spontaneously or with minimal intervention, does not increase the hospital length of stay, and does not cause permanent disability. Moderate (2) refers to the need for significant intervention, prolongation of hospitalization more than 24 hours, and at most, minor permanent disability that does not interfere with normal daily activity. A severe complication (3) needs major surgical, endovascular or medical intervention, may be associated with prolonged convalescence, is usually accompanied by prolonged or permanent disability, and may result in death.

Conditions

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Arterial Diseases, Carotid

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Group carotid endarterectomy (CEA)

Patients submitted to carotid endarterectomy

No interventions assigned to this group

Group carotid stenting (CAS)

Patients submitted to carotid artery stenting

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Patients with carotid stenosis \> 70% who wil be underwent to carotid endarterectomy or carotid artery stenting.

Exclusion Criteria

* Need to concomitant cardiac surgery.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Sao Paulo

OTHER

Sponsor Role lead

Responsible Party

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Edwaldo Edner Joviliano

MD; PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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EDWALDO E JOVILIANO, MD; PHD

Role: PRINCIPAL_INVESTIGATOR

University of Sao Paulo

Locations

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University Hospital of Botucatu Medical School

Botucatu, São Paulo, Brazil

Site Status RECRUITING

University Hospital of School of Medical Sciences UNICAMP

Campinas, São Paulo, Brazil

Site Status RECRUITING

University Hospital of Marilia Medical School

Marília, São Paulo, Brazil

Site Status RECRUITING

University Hospital of Ribeirao Preto Medical School, University of São Paulo

Ribeirão Preto, São Paulo, Brazil

Site Status RECRUITING

University Hospital of São Jose do Rio Preto Medical School

São José do Rio Preto, São Paulo, Brazil

Site Status RECRUITING

Countries

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Brazil

Central Contacts

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Edwaldo E Joviliano, MD; PhD

Role: CONTACT

5516981375511

Winston B Yoshida, MD; PhD

Role: CONTACT

5514997983664

Facility Contacts

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Winston B Yoshida, MD; PhD

Role: primary

551638116269

Marcone L Sobreira, MD; PhD

Role: backup

551438116269

Ana T Guillaumon, MD; PhD

Role: primary

5519981849370

Marcelo J Almeida, MD; PhD

Role: primary

5514996012417

Edwaldo E Joviliano, MD; PhD

Role: primary

551636021000 ext. 2406

Winston B Yoshida, MD; PhD

Role: backup

551438116269

Selma R Raymundo, MD; PhD

Role: primary

5517996016062

References

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Joviliano EE, Ribeiro MS, Sobreira ML, Moura R, Geiger MA, Guillamon AT, Regina de Oliveira Raymundo S, Miquelin DG, Hafner L, Almeida MJ, Oliveira TF, Dalio MB, Yoshida WB. Short-Term Outcomes of Transfemoral Carotid Artery Stenting and Carotid Endarterectomy in Symptomatic Patients: Data from a Multicentric Prospective Registry in Brazil. Ann Vasc Surg. 2022 Sep;85:41-48. doi: 10.1016/j.avsg.2022.04.053. Epub 2022 May 16.

Reference Type DERIVED
PMID: 35589029 (View on PubMed)

Joviliano EE, Yoshida WB, Sobreira ML, Moura R, Guillaumon AT, Raymundo SR, Miquelin DG, Hafner L, Almeida MJ. An Observational Registry of Carotid Endarterectomy and Carotid Artery Stenting in Brazil: Study Protocol. JMIR Res Protoc. 2016 Nov 23;5(4):e226. doi: 10.2196/resprot.5986.

Reference Type DERIVED
PMID: 27881360 (View on PubMed)

Other Identifiers

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01/2013

Identifier Type: -

Identifier Source: org_study_id

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