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Carotid Artery Disease After Stroke (CADAS). (CADAS)

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ClinicalTrials.gov Identifier: NCT03721523
Recruitment Status : Not yet recruiting
First Posted : October 26, 2018
Last Update Posted : October 30, 2018
Sponsor:
Collaborator:
Manchester University NHS Foundation Trust
Information provided by (Responsible Party):
Alison Phair, University of Manchester

Brief Summary:

Stroke is a significant medical problem with 150,000 events occurring per year in the UK and incurring healthcare costs of £4 billion per year. Fifty percent of strokes will leave a lasting disability on first manifestation and 10-15% (roughly 16,500 per year) are unheralded ischaemic events in previously asymptomatic Carotid artery disease.

Carotid Artery Disease is caused by the formation of an atherosclerotic plaque in the vessel. Stroke or TIA occurs when plaque or adherent thrombus breaks off and embolises to the brain, blocking off its blood supply. Hence, a carotid plaque is said to be symptomatic if it has caused a Stroke or TIA in the territory of the brain supplied by that vessel in the previous six months.

Currently, the degree of stenosis (narrowing) of the artery by doppler ultrasound is the main assessment performed. Doppler ultrasound measures stenosis and elevation of blood flow velocity in the artery prior to surgical intervention. However, it has been shown that the degree of stenosis is a poor predictor of stroke as many asymptomatic patients have severe stenosis and many symptomatic patients have moderate stenosis. Stenosis is a two dimensional assessment of a 3-D structure.

Other features of the plaque should be considered including the volume of the carotid plaque and its constituents. Carotid Plaque Volume has been measured in 339 individuals, with plaque volume being higher in symptomatic than asymptomatic individuals. In this study, plaque volume did not correlate with stenosis degree. No studies have been conducted measuring the change in carotid plaque volume and morphology following a stroke. This pilot study will perform serial duplex scans on recently symptomatic individuals over a 12 week period and observe the changes in Plaque Volume and morphology. This will attempt to prove that carotid plaque volume is a better predictor of stroke than stenosis. The investigators will also aim to identify other plaque features that may have an important role in predicting stroke risk. Documenting the timescale of change in plaque volume will aid us in defining appropriate timescales for treating the symptomatic population and when those having medical management's risk has returned to baseline. Observing the change in plaque immediately after stroke will improve our knowledge of the changes in plaques that lead to symptoms and may in the future help us predict which patients with asymptomatic carotid stenosis need operation.


Condition or disease Intervention/treatment
Carotid Artery Diseases Stroke Transient Ischemic Attack Diagnostic Test: 3 Dimensional tomographic Ultrasound Diagnostic Test: Platelet Aggregometry

  Show Detailed Description

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Study Type : Observational
Estimated Enrollment : 15 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Observational Cohort Study of Changes in Carotid Plaque Volume After Stroke.
Estimated Study Start Date : November 1, 2018
Estimated Primary Completion Date : November 1, 2020
Estimated Study Completion Date : November 1, 2021

Resource links provided by the National Library of Medicine



Intervention Details:
  • Diagnostic Test: 3 Dimensional tomographic Ultrasound
    3-D tUS at five timepoints following acute ipsilateral stroke or Transient Ischaemic attack (TIA) to document carotid plaque volume and presence or absence of adverse plaque features.
  • Diagnostic Test: Platelet Aggregometry
    Blood test to test for platelet resistance to aspirin or clopidogrel and to measure effect of acute inflammatory response post event.


Primary Outcome Measures :
  1. Changes in Carotid Plaque Volume using 3-D tomographic Ultrasound over time following acute cerebral event. [ Time Frame: Measured at 5 separate timepoints up to 12 weeks following acute cerebral event. ]
    Measured by 3-D tUS with contrast administration


Secondary Outcome Measures :
  1. Identify adverse morphological features within the carotid plaque by 3-D tomographic Ultrasound. [ Time Frame: At five timepoints over 12 weeks. ]
    Duplex ultrasound to identify intraplaque haemorrhage, fibrous cap thickness, ulceration, juxtaluminal black area.

  2. Assess the acute inflammatory response to stroke on platelet aggregation and resistance to antiplatelet agents. [ Time Frame: Twice during study period ]
    Platelet aggregometry blood test.



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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Patients with recent stroke, with carotid artery disease not being considered for surgery.
Criteria

Inclusion Criteria:

  • Patients with capacity to give informed consent. All patients who have suffered a Partial Anterior Circulatory Stroke (PACS) or Transient Ischaemic Attack (TIA).

Carotid Stenosis >50%.

Exclusion Criteria:

  • Lacking capacity. Carotid Artery occlusion. Allergy to contrast agent. Significant disability or immobility such that participation would cause stress.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03721523


Contacts
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Contact: Alison S Phair, MBBS 07793004089 ext 07793004089 alison.phair@manchester.ac.uk
Contact: Charles McCollum, Prof. 01612915853 charles.mccollum@manchester.ac.uk

Locations
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United Kingdom
Manchester Foundation Trust, Wythenshawe site. Not yet recruiting
Manchester, United Kingdom
Contact: Alison Phair, MBBS    07793004089 ext 07793004089    alison.phair@manchester.ac.uk   
Principal Investigator: Charles McCollum, Professor of Surgery         
Sponsors and Collaborators
University of Manchester
Manchester University NHS Foundation Trust

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Responsible Party: Alison Phair, Carotid Clinical Research Fellow, University of Manchester
ClinicalTrials.gov Identifier: NCT03721523     History of Changes
Other Study ID Numbers: UHSMCADAS
First Posted: October 26, 2018    Key Record Dates
Last Update Posted: October 30, 2018
Last Verified: October 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Stroke
Ischemic Attack, Transient
Carotid Artery Diseases
Cerebrovascular Disorders
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Vascular Diseases
Cardiovascular Diseases
Brain Ischemia