Extracranial Carotid & Intracranial Arterial Stenosis in Ischemic Stroke

NCT ID: NCT04162587

Last Updated: 2019-11-19

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

120 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-05-01

Study Completion Date

2020-08-01

Brief Summary

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The aim of the work is to; elucidate how the presence of carotid stenosis influence the pattern of stroke and also how it interact with other risk factors for stroke. Also identify predictors of intracranial stenosis and outcome in patients with carotid stenosis with or without intracranial stenosis.

Detailed Description

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Patients:

Ischemic stroke patients admitted to Neurology department in Mansoura University hospital (MUH) will be studied

The patients will be grouped as follow:

1. Patients with significant carotid stenosis without intracranial stenosis.
2. Patients with carotid and intracranial stenosis.
3. Patients with lone intracranial stenosis.
4. patients with no significant carotid or intracranial stenosis.

Methods:

Studied patients will undergo the following:

* Clinical assessment with NIH scale with is a systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficit, Modified Rankin Scale, Arabic version of Montereal Coginitive Assessment and Arabic version of Beck's Depression Inventory at presentation and after 6 months.
* carotid duplex+/- MRA neck and brain MRA+/-CT angio on carotid and brain (at 0day) and 6m after.
* MRI brain with diffusion to detect asymptomatic stroke at 0 day and 6 months later.
* DSA (digital subtraction angiography) in some cases to confirm diagnosis.
* Laboratory investigations: complete blood count, liver function and renal function tests, random blood sugar, lipid profile.

All patients will be treated with acetyle-salicylic acid(150/day) +/-clopidogrel (75mg /day) +/- statins, plus modification of risk factors.

Conditions

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Ischemic Stroke Carotid Stenosis

Study Design

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Observational Model Type

CASE_CONTROL

Study Time Perspective

RETROSPECTIVE

Study Groups

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1)Patients with significant carotid stenosis only

Patients with significant carotid stenosis without intracranial stenosis.

Carotid duplex+/- MRA neck

Intervention Type OTHER

Carotid duplex and or MRA neck

brain MRA+/-CT angio on carotid and brain

Intervention Type OTHER

brain MRA and or CT angiography on carotid and brain

MRI brain

Intervention Type OTHER

MRI brain with diffusion to detect asymptomatic stroke

DSA (digital subtraction angiography)

Intervention Type OTHER

DSA (digital subtraction angiography) in some cases to confirm diagnosis.

2) Patients with carotid and intracranial stenosis.

Patients with carotid and intracranial stenosis.

Carotid duplex+/- MRA neck

Intervention Type OTHER

Carotid duplex and or MRA neck

brain MRA+/-CT angio on carotid and brain

Intervention Type OTHER

brain MRA and or CT angiography on carotid and brain

MRI brain

Intervention Type OTHER

MRI brain with diffusion to detect asymptomatic stroke

DSA (digital subtraction angiography)

Intervention Type OTHER

DSA (digital subtraction angiography) in some cases to confirm diagnosis.

3) Patients with lone intracranial stenosis.

Patients with lone intracranial stenosis.

Carotid duplex+/- MRA neck

Intervention Type OTHER

Carotid duplex and or MRA neck

brain MRA+/-CT angio on carotid and brain

Intervention Type OTHER

brain MRA and or CT angiography on carotid and brain

MRI brain

Intervention Type OTHER

MRI brain with diffusion to detect asymptomatic stroke

DSA (digital subtraction angiography)

Intervention Type OTHER

DSA (digital subtraction angiography) in some cases to confirm diagnosis.

4) Patients with no significant stenosis

Patients with no significant carotid or intracranial stenosis.

Carotid duplex+/- MRA neck

Intervention Type OTHER

Carotid duplex and or MRA neck

brain MRA+/-CT angio on carotid and brain

Intervention Type OTHER

brain MRA and or CT angiography on carotid and brain

MRI brain

Intervention Type OTHER

MRI brain with diffusion to detect asymptomatic stroke

Interventions

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Carotid duplex+/- MRA neck

Carotid duplex and or MRA neck

Intervention Type OTHER

brain MRA+/-CT angio on carotid and brain

brain MRA and or CT angiography on carotid and brain

Intervention Type OTHER

MRI brain

MRI brain with diffusion to detect asymptomatic stroke

Intervention Type OTHER

DSA (digital subtraction angiography)

DSA (digital subtraction angiography) in some cases to confirm diagnosis.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Carotid TIA (transient ischemic attack) it should, however, be focal and usually motor-sensory to implicate the carotid artery system or ischemic stroke involving carotid territory.
* Asymptomatic patients with carotid stenosis or anterior circulation stenosis discovered accidentally during investigations for further risk factors.

Exclusion Criteria

* Major functional impairment (Modified Rankin Scale \>/= 3)
* Significant cognitive impairment.
* Contraindication to acetylsalicylic or dual antiplatelet.
* Renal dysfunction precluding safe contrast medium administration.
* pregnancy or refusal.
* Intracranial aneurysm or AVM.
* Intra cerebral hemorrhage or hemorrhagic infarction.
Minimum Eligible Age

40 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Mansoura University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Ahmed Esmael

Assistant Prof of Neurology

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Esmael M Ahmed, MD

Role: PRINCIPAL_INVESTIGATOR

Assistant Prof of Neurology

Locations

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Mansoura University Hospital

Al Mansurah, , Egypt

Site Status RECRUITING

Countries

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Egypt

Central Contacts

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Esmael M Ahmed, MD

Role: CONTACT

00201000372787

Facility Contacts

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Esmael M Ahmed, MD

Role: primary

00201000382898

References

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Bonita R, Beaglehole R. Recovery of motor function after stroke. Stroke. 1988 Dec;19(12):1497-500. doi: 10.1161/01.str.19.12.1497.

Reference Type RESULT
PMID: 3201508 (View on PubMed)

Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER 3rd, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation. 2014 Jan 21;129(3):e28-e292. doi: 10.1161/01.cir.0000441139.02102.80. Epub 2013 Dec 18. No abstract available.

Reference Type RESULT
PMID: 24352519 (View on PubMed)

Josephson SA, Hills NK, Johnston SC. NIH Stroke Scale reliability in ratings from a large sample of clinicians. Cerebrovasc Dis. 2006;22(5-6):389-95. doi: 10.1159/000094857. Epub 2006 Aug 4.

Reference Type RESULT
PMID: 16888381 (View on PubMed)

Lee SJ, Cho SJ, Moon HS, Shon YM, Lee KH, Kim DI, Lee BB, Byun HS, Han SH, Chung CS. Combined extracranial and intracranial atherosclerosis in Korean patients. Arch Neurol. 2003 Nov;60(11):1561-4. doi: 10.1001/archneur.60.11.1561.

Reference Type RESULT
PMID: 14623728 (View on PubMed)

Loftus CM, Harbaugh RE, Fleck JD, Biller J. Carotid occlusive disease: natural history and medical management. In: Winn HR, ed. Youman's Neurological Surgery. 6th ed. Philadelphia, PA: WB Saunders; 2011:3616.

Reference Type RESULT

Pinzon R, Asanti L, Sugianto, Widyo K. Risk factors of intracranial stenosis among older adults with acute ischemic stroke. unversa Medicinia 2009;28:1-7.

Reference Type RESULT

Rahman TT, El Gaafary MM. Montreal Cognitive Assessment Arabic version: reliability and validity prevalence of mild cognitive impairment among elderly attending geriatric clubs in Cairo. Geriatr Gerontol Int. 2009 Mar;9(1):54-61. doi: 10.1111/j.1447-0594.2008.00509.x.

Reference Type RESULT
PMID: 19260980 (View on PubMed)

Sayed A, Ahmed S M, Abdelalim A M, Nagah M, Khairy H. Is peripheral arterial disease associated with carotid artery disease in Egyptians? A pilot study. The Egyptian Journal of Neurology, Psychiatry and neurosurgery 2016;53:12-18.

Reference Type RESULT

Sung YF, Lee JT, Tsai CL, Lin CC, Hsu YD, Lin JC, Chu CM, Peng GS. Risk Factor Stratification for Intracranial Stenosis in Taiwanese Patients With Cervicocerebral Stenosis. J Am Heart Assoc. 2015 Dec 15;4(12):e002692. doi: 10.1161/JAHA.115.002692.

Reference Type RESULT
PMID: 26672078 (View on PubMed)

Wong KS, Li H. Long-term mortality and recurrent stroke risk among Chinese stroke patients with predominant intracranial atherosclerosis. Stroke. 2003 Oct;34(10):2361-6. doi: 10.1161/01.STR.0000089017.90037.7A. Epub 2003 Aug 28.

Reference Type RESULT
PMID: 12947158 (View on PubMed)

Other Identifiers

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Mansoura University Hospital 4

Identifier Type: -

Identifier Source: org_study_id

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