" Endarterectomy Combined With Optimal Medical Therapy (OMT) vs OMT Alone in Patients With Asymptomatic Severe Atherosclerotic Carotid Artery Stenosis at Higher-than-average Risk of Ipsilateral Stroke "

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

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

43 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-09-16

Study Completion Date

2022-01-13

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

The purpose of this study is to determine whether carotid surgery combined with optimal medical therapy improves long-term survival free of ipsilateral stroke in patients with asymptomatic carotid stenosis at higher-than-average risk of ipsilateral stroke when compared with optimal medical therapy alone.

Related Clinical Trials

Explore similar clinical trials based on study characteristics and research focus.

Endarterectomy Versus Stenting in Patients With Symptomatic Severe Carotid Stenosis - 2

NCT07054060

Stroke

RECRUITING NA

Early Warning and Optimization Strategy in Carotid Endarterectomy

NCT01210937

Carotid Stenosis Carotid Artery Diseases Stroke +1 more

UNKNOWN PHASE4

Correlation Between Carotid Stump Pressure and Interhemispheric rSO₂ Asymmetry During Awake Carotid Endarterectomy

NCT07150260

Carotid Artery Stenosis Symptomatic Carotid Endarterectomy (CEA) Surgical Patients Cerebral Hypoperfusion

RECRUITING

SONOlysis in Prevention of Brain Infarctions dUring Carotid Stenting and caroTid EndaRterectomy

NCT01591005

Internal Carotid Artery Stenosis

COMPLETED PHASE3

Reconstruction of the Carotid Bifurcation in Patients With Arterial Hypertension of 2-3 Degrees

NCT05931003

Hypertension Carotid Stenosis Symptomatic Carotid Artery Stenosis

ACTIVE_NOT_RECRUITING NA

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Carotid artery stenosis \>= 50% affects about 3% of subjects \>= 60 years and accounts for up to 15% of all ischemic strokes. Overall, patients with asymptomatic carotid stenosis have a low risk of ipsilateral stroke on modern medical therapy. It is therefore uncertain whether the benefit of carotid surgery still justifies the perioperative risk of stroke or death, and whether revascularisation is good value for money considering competing demands on health services. Several imaging techniques have been developed to identify patients with asymptomatic carotid stenosis at higher-than-average risk of ipsilateral stroke. Specifically, the presence of transcranial Doppler (TCD)-detected embolic signals, intraplaque haemorrhage on magnetic resonance imaging, TCD-measured impaired cerebral vasomotor reserve or rapid stenosis progression have all been shown to involve an at least 3-fold higher risk of ipsilateral stroke. However, before recommendations for clinical practice can be made regarding the use of these tools, their utility must be demonstrated in a formal randomised clinical trial. Our hypothesis is that the use of these predictors can identify a subset of patients with asymptomatic carotid stenosis who could benefit from prophylactic endarterectomy.

Carotid endarterectomy The procedure will be carried out with the technique routinely used by each surgeon. Operative reports and perioperative complications will be collected. CEA will have to be performed as soon as possible, within 60 days after randomization.

Optimal medical therapy OMT will be applied to all patients and started immediately after randomisation.

OMT will be defined by the adhoc committee and follow relevant guidelines. It will include:

* Antiplatelet therapy. If the patient requires anticoagulation for any reason (e.g. atrial fibrillation), the patient should be treated with an appropriate anticoagulant according to the practice at the centre as an alternative to antiplatelet therapy.
* Antihypertensive treatment, if required, to achieve a target blood pressure \< 140/90 mmHg (higher targets may be defined by the OMT committee for selected conditions, e.g. contralateral carotid occlusion) Application of structured programs, such as stepped-care approach using ranking of antihypertensive drugs will be used.
* High-dose statin treatment (target LDL \< 0.7 g/l). A stepped-care approach with raking of lipid-lowering drugs will also be used.
* Patients smoking at the time of randomisation will be encouraged to stop and join a smoking cessation and support program.
* Other lifestyle modification: reduction of alcohol consumption, choosing healthy food, increasing regular physical activity, reduction of body weight if relevant.

OMT may be modified during the course of the trial to take account revised guidelines or new evidence.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Asymptomatic Carotid Artery Stenosis

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Carotid endarterectomy combined with optimal medical therapy

Carotid endarterectomy (CEA) combined with optimal medical therapy (OMT)

Intervention Type DRUG

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Age 50 years or over
* No ipsilateral stroke or TIA within 180 days of randomization
* Atherosclerotic carotid stenosis between 70 and 99% (NASCET method)
* At least one of the following markers of ipsilateral stroke risk:

* Silent brain infarction on MRI, DWi, consistent with embolism from or hemodynamic consequences of the qualifyiing stenosis
* History of contralateral TIA or ischemic stroke due to atherosclerotic carotid disease
* Predominantly echolucent plaque on ultrasound
* Rapid (within 1 year) carotid stenosis progresion
* TCD-detected microembolic signals
* Impairment of TCD-measured cerebral vasomotor reserve
* Intraplaque haemorrhage on magnetic resonance imaging
* Rapid and severe stenosis progression
* Patient is able and willing to give informed consent

Exclusion Criteria

* Previous revascularization procedure in the artery to be randomised
* Patients not suitable for endarterectomy due to anatomical factors
* Carotid stenosis caused by non-atherosclerotic disease e.g. neck radiotherapy or fibromuscular disease
* Patients who have had contralateral carotid artery or vertebral artery or intracranial artery revascularisation within 6 weeks prior to randomisation
* Patients with planned revascularisation of the contralateral carotid artery or a vertebral artery or an intracranial artery within 6 weeks after randomisation or the date of CEA
* Patients who have had coronary artery bypass grafting within 3 months prior to randomisation or other major surgery within 6 weeks prior to randomisation
* Patients with planned coronary artery bypass grafting or other major surgery within 6 weeks after CEA of the artery considered for treatment in the trial
* Patients with pre-existing disability (modified Rankin score greater than 2)
* Patients who have a low 5-year life expectancy (see appendix for definition)
* Patients intolerant or allergic to all of the medications available for OMT
* Patients in clinical trials of investigational medicinal products or who have been in clinical trials within the last 4 months will not be enrolled unless otherwise agreed
* Patients who are known to be pregnant
* Patients unwilling or unable to participate in follow-up

Minimum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No