Neurocognitive Function After Carotid Thrombendarterectomy

NCT ID: NCT05739357

Last Updated: 2023-11-30

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

COMPLETED

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-08-01

Study Completion Date

2023-10-01

Brief Summary

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Previous studies did not reach a consensus on the influence of the type of anesthesiologic procedure and monitoring, during carotid thrombendarterectomy, on perioperative complications and cognitive outcomes. The aim of this study is the optimization of brain perfusion during the vascular carotid clamp using multimodal monitoring. We assume that standardized monitoring techniques and a better selection of cognitive tests will allow a more accurate assessment of subclinical cognitive deficits.

Detailed Description

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ABSTRACT:

AIM OF THE STUDY: Effect of perioperative multimodal monitoring with transcranial doppler (TCD), near-infrared spectroscopy (NIRS), and Electroencephalography (EEG) in patients for carotid thrombendarterectomy (CEA) on perioperative complications and cognitive functions.

PATIENTS AND METHODS: The prospective study will analyze 80 consecutive patients with an asymptomatic and symptomatic (transitory ischemic attack, TIA, in anamnesis) stenosis of the internal carotid artery in which CEA is indicated in general anesthesia. Cognitive tests will be analyzed for all patients preoperatively, first and eighth day postoperatively, and after 8 weeks. Breath-holding index (BHI) will be measured preoperatively and postoperatively. The first group of patients (n = 40) will have expanded intraoperative monitoring involving TCD, NIRS, and EEG, and the control group (n = 40) will have only standard anesthetic monitoring.

EXPECTED CONTRIBUTION OF THE STUDY: Previous studies did not agree on the influence of the type of anesthesiologic procedure and monitoring of perioperative complications and cognitive outcomes. We assume that standardized monitoring techniques and a better selection of cognitive tests will allow a more accurate assessment of the effect.

Conditions

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Carotid Stenosis Postoperative Cognitive Dysfunction Neurological Impairment

Keywords

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CEA ACI cognitive tests BHI NIRS TCD EEG

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Cerebral perfusion monitoring

Multimodal monitoring includes cerebral oxygenation (with NIRS) and EEG (with SEDLINE). During the carotic clamp, if cerebral oxygenation decreased for more than 12 % on the operating side from the baseline value, simple interventions as, increasing arterial blood pressure, increasing arterial carbon dioxide tension or increasing oxygen inspiration concentration will be performed.

Group Type ACTIVE_COMPARATOR

NIRS, EEG

Intervention Type DEVICE

During the carotic clamp, if cerebral oxygenation decreased for more than 12 % on the operating side from the baseline value, simple interventions as, increasing arterial blood pressure, increasing arterial carbon dioxide tension or increasing oxygen inspiration concentration will be performed.

Control

The control arm does not have any monitor of cerebral perfusion and oxygenation, during the carotic clamp only intervention is regulating arterial blood pressure values.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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NIRS, EEG

During the carotic clamp, if cerebral oxygenation decreased for more than 12 % on the operating side from the baseline value, simple interventions as, increasing arterial blood pressure, increasing arterial carbon dioxide tension or increasing oxygen inspiration concentration will be performed.

Intervention Type DEVICE

Other Intervention Names

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cerebral oximetry

Eligibility Criteria

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Inclusion Criteria

* patients with The North American Symptomatic Carotid Endarterectomy Trial (NASCET) stenosis of more than 70%
* symptomatic stenosis
* asymptomatic stenosis
* elective surgery patients
* signed informed consent
* initial MoCa test equal and more than 22

Exclusion Criteria

* who refuse to participate
* previous stroke in anamnesis
* patient without bone window for BHI measurements
* comorbidities with aphasia and plegia, and the impossibility to solve cognitive tests
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Clinical Hospital Centre Zagreb

OTHER

Sponsor Role lead

Responsible Party

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Tina Tomic Mahecic

Consultant anesthesiologist

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Tina Tomic Mahecic

Role: PRINCIPAL_INVESTIGATOR

UHC Zagreb

Locations

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UHCZagreb

Zagreb, , Croatia

Site Status

Countries

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Croatia

Other Identifiers

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UHCZagreb 02/21 AG

Identifier Type: -

Identifier Source: org_study_id