Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: Risk Reduction of Symptomatic and Silent Brain Infarctions During Carotid Endarterectomy and Carotid Stenting Due to Ultrasound Activation of Endogenous Fibrinolytic System Using Transcranial Doppler Monitoring
Brief Summary: The aim of the project is to demonstrate a fibrinolytic effect of sonothrombolysis (continual transcranial Doppler monitoring) using 2 MegaHertz (MHz) diagnostic probe on the reduction of risk of brain infarctions due to the activation of endogenous fibrinolytic system during carotid endarterectomy (CEA) and carotid stenting (CS). 240 patients indicated for CEA (120 patients) and CS (120 patients) will be enrolled into the study in order to demonstrate a twenty-percent risk reduction of number and volume of brain infarctions detected using MRI examination 24 hours after CEA or CS in 5% level of significance. Patients will be randomized - subgroup 1 will undergo a 60minute non-diagnostic transcranial Doppler (TCD) monitoring during CEA or CS, subgroup 2 will undergo interventions without TCD monitoring. The second aim is to compare number of brain infarctions detected using MRI between CEA and CS patients.

Confirmation of the investigators hypothesis that sonothrombolysis is able to activate endogenous fibrinolytic system during CEA or CS with consecutive reduction of the number and volume of brain infarcts, can lead to the increase of the safety of CEA and CS in patients with internal carotid artery stenosis. The investigators can presume that up to 50% of patients indicated for CEA or CS can be treated using these methods in the future.

In the Substudy "Risk of brain infarction after carotid endarterectomy and stenting" the the risk of asymptomatic and symptomatic brain infarctions, changes in cognitive functions, as well as morbidity and mortality at 30 days between patients with symptomatic and asymptomatic severe internal carotid artery (ICA) stenoses undergoing elective CEA and CAS will be compared.

The sample size of the Substudy was based on an expected 80% difference of new ischemic lesions on DWI-MRI between CEA (estimated prevalence, 30%) and CAS (54%). Pre-study calculations showed that a minimum of 73 patients in each group was needed to reach a significant difference with an alpha value of 0.05 (two-tailed) and a beta value of 0.8 assuming that 15% of subjects would be lost to follow-up or refuse to participate in the study.


Options:
A: Arm Label: Carotid Artery Endarterectomy (CEA); Type: ACTIVE_COMPARATOR; Interventions: Procedure: Carotid Endarterectomy (CEA) | Arm Label: Carotid Artery Stenting (CAS); Type: ACTIVE_COMPARATOR; Interventions: Device: Carotid Artery Stenting (CAS) | Intervention Type: PROCEDURE; Name: Carotid Endarterectomy (CEA); Assigned to Arm(s): Carotid Artery Endarterectomy (CEA) | Intervention Type: DEVICE; Name: Carotid Artery Stenting (CAS); Assigned to Arm(s): Carotid Artery Stenting (CAS)
B: Arm Label: CEA with sonolysis; Type: EXPERIMENTAL; Interventions: Procedure: sonolysis, Procedure: endarterectomy | Arm Label: CEA without sonolysis; Type: PLACEBO_COMPARATOR; Interventions: Procedure: endarterectomy | Arm Label: carotid stenting with sonolysis; Type: EXPERIMENTAL; Interventions: Procedure: sonolysis, Procedure: carotid stenting | Arm Label: carotid stenting without sonolysis; Type: PLACEBO_COMPARATOR; Interventions: Procedure: carotid stenting | Intervention Type: PROCEDURE; Name: sonolysis; Assigned to Arm(s): CEA with sonolysis, carotid stenting with sonolysis | Intervention Type: PROCEDURE; Name: endarterectomy; Assigned to Arm(s): CEA with sonolysis, CEA without sonolysis | Intervention Type: PROCEDURE; Name: carotid stenting; Assigned to Arm(s): carotid stenting with sonolysis, carotid stenting without sonolysis
C: Arm Label: 1; Type: ACTIVE_COMPARATOR; Interventions: Device: Carotid artery stenting with filter (interventional) | Arm Label: 2; Type: ACTIVE_COMPARATOR; Interventions: Procedure: Carotid artery endarterectomy (surgical) | Intervention Type: DEVICE; Name: Carotid artery stenting with filter (interventional); Assigned to Arm(s): 1 | Intervention Type: PROCEDURE; Name: Carotid artery endarterectomy (surgical); Assigned to Arm(s): 2
D: Arm Label: 1; Type: EXPERIMENTAL; Interventions: Device: Carotid angioplasty and stenting with cerebral protection | Intervention Type: DEVICE; Name: Carotid angioplasty and stenting with cerebral protection; Assigned to Arm(s): 1

Answer: B