Perioperative Argon Inhalation to Improve Neurocognitive Recovery After Carotid Surgery

NCT ID: NCT07200180

Last Updated: 2025-09-30

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

NOT_YET_RECRUITING

Clinical Phase

PHASE3

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-10-01

Study Completion Date

2026-11-01

Brief Summary

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Currently, over 400,000 reconstructive surgeries on carotid arteries are performed annually worldwide, including carotid endarterectomy (CEA) and carotid stenting. These interventions have proven effective in preventing ischemic stroke in patients with hemodynamically significant carotid artery stenoses. However, even following a technically successful procedure, the risk of perioperative ischemic brain injury persists. According to meta-analyses, one in five patients exhibits covert ("silent") strokes after reconstructive interventions, with their frequency being ten times higher than that of clinically manifest events. Such lesions are associated with cognitive decline and an increased risk of dementia. An additional risk factor is the "no-reflow" phenomenon-an impairment of microcirculatory reperfusion that occurs even after the restoration of macrovascular blood flow, thereby limiting the effectiveness of surgical revascularization.

Cognitive disorders and postoperative delirium, observed in 15-30% of patients after CEA, adversely affect rehabilitation and long-term prognosis. To date, there are no reliable pharmacological strategies to prevent these complications.

In this context, inert gases have attracted significant interest as potential neuroprotective agents. Xenon, despite its proven efficacy, is limited by high cost and challenges in industrial production. Argon, in contrast, is accessible, safe, and technologically straightforward to administer. In preclinical models of stroke and ischemia-reperfusion, argon has demonstrated pronounced anti-apoptotic, anti-inflammatory, and antioxidant effects, mediated through the regulation of TLR2/4-, ERK1/2-, Nrf2-, and NF-κB-dependent signaling pathways. Its ability to suppress microglial activation towards the M1 phenotype and inhibit the NLRP3 inflammasome has been noted, which reduces neuroinflammation and decreases the volume of secondary neuronal damage. Short-term argon inhalation in healthy volunteers has shown a favorable safety profile with no adverse effects on cerebral hemodynamics.

Thus, it is highly relevant to clinically test the hypothesis that perioperative inhalation of an argon-containing gas mixture can reduce the incidence of ischemic brain injuries and cognitive impairments in patients undergoing CEA.

Detailed Description

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Conditions

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Carotid Artery Disease Carotid Artery Stenoses

Keywords

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Carotid artery disease Carotid artery stenosis Carotid artery surgery Neurocognitive disorders postoperative delirium Stroke Neuroinflammation Argon Organ protection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Caregivers Outcome Assessors

Study Groups

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Аrgon-oxygen breathing mixture

Perioperative inhalation of an argon-oxygen mixture (70% argon, 30% oxygen)

Group Type EXPERIMENTAL

Аrgon-oxygen breathing mixture

Intervention Type DRUG

Patients receive a course of inhalations with an argon-oxygen mixture according to the following protocol: 60 minutes on day 1 prior to surgery, 60 minutes one hour before being transferred to the operating room, and 60 minutes on the first postoperative day

Nitrogen-oxygen breathing mixture

Perioperative inhalation of an nitrogen-oxygen mixture (70% nitrogen, 30% oxygen)

Group Type SHAM_COMPARATOR

Nitrogen-oxygen breathing mixture

Intervention Type DRUG

Patients receive a course of inhalations with an nitrogen-oxygen mixture according to the following protocol: 60 minutes on day 1 prior to surgery, 60 minutes one hour before being transferred to the operating room, and 60 minutes on the first postoperative day

Interventions

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Аrgon-oxygen breathing mixture

Patients receive a course of inhalations with an argon-oxygen mixture according to the following protocol: 60 minutes on day 1 prior to surgery, 60 minutes one hour before being transferred to the operating room, and 60 minutes on the first postoperative day

Intervention Type DRUG

Nitrogen-oxygen breathing mixture

Patients receive a course of inhalations with an nitrogen-oxygen mixture according to the following protocol: 60 minutes on day 1 prior to surgery, 60 minutes one hour before being transferred to the operating room, and 60 minutes on the first postoperative day

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* age \> 18 years
* elective carotid artery surgery
* general anesthesia
* written informed consent

Exclusion Criteria

* The presence of any mental disorder according to the International Classification of Diseases 10th Revision which is confirmed by a psychiatrist.
* The presence of any neuromuscular disease according to the International Classification of Diseases 10th Revision
* Heart failure equal 3 or 4 class according to the New York Heart Association Functional Classification
* Pregnant or breast-feeding women
* Inability to undergo a preoperative assessment for any reason
* Previously enrolled in this trial
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Negovsky Reanimatology Research Institute

OTHER_GOV

Sponsor Role lead

Responsible Party

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Oleg A. Grebenchikov

The head of the laboratory in the Negovsky Reanimatology Research Institute

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Oleg Grebenchikov, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Negovsky Reanimatology Research Institute

Locations

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Demikhov Municipal Clinical Hospital 68

Moscow, , Russia

Site Status

Countries

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Russia

Central Contacts

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Oleg Grebenchikov, MD, PhD

Role: CONTACT

Phone: +79686494147

Email: [email protected]

Facility Contacts

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Viktoriya Antonova, MD, PhD

Role: primary

Other Identifiers

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PAIRS

Identifier Type: -

Identifier Source: org_study_id