Extracranial Carotid & Intracranial Arterial Stenosis in Ischemic Stroke

Mansoura University Hospital

Status: Unknown

Conditions: Ischemic Stroke; Carotid Stenosis

Treatments: Other: DSA (digital subtraction angiography); Other: Carotid duplex+/- MRA neck; Other: brain MRA+/-CT angio on carotid and brain; Other: MRI brain

Study type: Observational

Funder types: Other

Identifiers

NCT04162587

Mansoura University Hospital 4

Details and patient eligibility

About

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.

Full description

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.

Enrollment: 120 estimated patients

Sex: All

Ages: 40+ years old

Volunteers: Accepts Healthy Volunteers

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.

Trial design

120 participants in 4 patient groups

1)Patients with significant carotid stenosis only

Description:

Patients with significant carotid stenosis without intracranial stenosis.

Treatment:

Other: DSA (digital subtraction angiography)

Other: Carotid duplex+/- MRA neck

Other: brain MRA+/-CT angio on carotid and brain

Other: MRI brain

2) Patients with carotid and intracranial stenosis.

Description:

Patients with carotid and intracranial stenosis.

Treatment:

Other: DSA (digital subtraction angiography)

Other: Carotid duplex+/- MRA neck

Other: brain MRA+/-CT angio on carotid and brain

Other: MRI brain

3) Patients with lone intracranial stenosis.

Description:

Patients with lone intracranial stenosis.

Treatment:

Other: DSA (digital subtraction angiography)

Other: Carotid duplex+/- MRA neck

Other: brain MRA+/-CT angio on carotid and brain

Other: MRI brain

4) Patients with no significant stenosis

Description:

Patients with no significant carotid or intracranial stenosis.

Treatment:

Other: Carotid duplex+/- MRA neck

Other: brain MRA+/-CT angio on carotid and brain

Other: MRI brain