Embolic Signals Detection Study (Esds) in Candidates for Surgical Carotid Revascularisation

Study Overview
=================
Brief Summary
-----------------
About 20% of strokes are caused by emboli deriving from a carotid plaque. In symptomatic patients with carotid stenosis grater than 70% the Carotid Endarterectomy (CEA) reduces stroke risk by about 75% and is generally accepted as being cost effective. However also in these cases there is a part of the population that, according to the morphological plaque characteristics, could better benefit from a conservative medical treatment. Improving the Best Medical Treatment, the situation seems to be even less clear in asymptomatic patients, where probably it would need to treat at least 32 patients in order to prevent one single ictus. Different parameters have been considered in order to determine, among the asymptomatic patients the ones that more than others could benefit from a surgical revascularisation instead of a medical treatment. Between these parameters, the quality of the plaque (vulnerability) and the micro-embolic signals (MES) detection with the Transcranial Doppler (TCD) Holter seems to be the most relevant. Another interesting aspect is trying to establish whether plaques can determine a different embolic risk in relation to the different histological findings. Therefore, it seems interesting and reasonable trying to establish a correlation between these two parameters in asymptomatic patients as in the symptomatic ones in order to make more and more appropriate a surgical plaque removal according to the specific risk of each patient in a set of tailored surgery. It consists in a descriptive observational study, since it intends to describe the embolic signals detection (MES) counted in automatic way with the TCD Holter, in patients affected by carotid stenosis, before and after the surgical operation. In particular it consists in a monocentric, longitudinal, prospective cohort study since it intends to analyse a group of patients (already candidates to CEA) that experiences a specific event (MES) before and after the surgical plaque removal, in a precise span of time. Since the treatment, removing the plaque, should remove the embolic focus too, a significant reduction of microembolic signals in post-operative time is expected. This reduction has been esteemed around about the 70% among candidates to CEA. Patients taken on responsibility of the equipe will undergo an ultrasonographic investigation for the carotid stenosis, histological characterization of the plaque based on the Gray-Weale classification and TCD-Holter for MES.

Official Title
-----------------
Embolic Signals Detection Study (Esds) in Candidates for Surgical Carotid Revascularisation: a Comparison With Plaque Histological Findings

Conditions
-----------------
Carotid Stenosis, Carotid Artery Diseases, Carotid Atherosclerosis, Carotid Artery Plaque, TCD, Stroke

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Informed consent signed Age>18y.o. Carotid stenosis >70% and/or vulnerable plaque Exclusion Criteria: Inability to give the informed consent Age<18y.o. Carotid stenosis < 70 % Patients already treated with CEA in the same seat Impossibility to find the insonation window Patients not in best medical treatment therapy

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------
What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| MES COUNT | number of MES | before surgery | 
| MES COUNT | number of MES | 24 hours after surgery | 
| MES COUNT | number of MES | after 30 days from the surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| RISK RATE | Estimate an association between MES count and plaque's histology | through study completion, an average of 60 days | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
carotid, carotid stenosis, plaque, stroke risk, transcranial doppler, TCD, histology