Extracranial Carotid & Intracranial Arterial Stenosis in Ischemic Stroke

Study Overview
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Brief Summary
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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.

Detailed Description
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Patients: Ischemic stroke patients admitted to Neurology department in Mansoura University hospital (MUH) will be studied The patients will be grouped as follow: Patients with significant carotid stenosis without intracranial stenosis. Patients with carotid and intracranial stenosis. Patients with lone intracranial stenosis. 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.

Official Title
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Association Between Extracranial Carotid & Intracranial Arterial Stenosis in Ischemic Stroke Patients: Predictors & Outcome

Conditions
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Ischemic Stroke, Carotid Stenosis

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


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| 1)Patients with significant carotid stenosis only<br>Patients with significant carotid stenosis without intracranial stenosis. | Other: Carotid duplex+/- MRA neck<br>* Carotid duplex and or MRA neck<br>Other: brain MRA+/-CT angio on carotid and brain<br>* brain MRA and or CT angiography on carotid and brain<br>Other: MRI brain<br>* MRI brain with diffusion to detect asymptomatic stroke<br>Other: DSA (digital subtraction angiography)<br>* DSA (digital subtraction angiography) in some cases to confirm diagnosis.<br>|
| 2) Patients with carotid and intracranial stenosis.<br>Patients with carotid and intracranial stenosis. | Other: Carotid duplex+/- MRA neck<br>* Carotid duplex and or MRA neck<br>Other: brain MRA+/-CT angio on carotid and brain<br>* brain MRA and or CT angiography on carotid and brain<br>Other: MRI brain<br>* MRI brain with diffusion to detect asymptomatic stroke<br>Other: DSA (digital subtraction angiography)<br>* DSA (digital subtraction angiography) in some cases to confirm diagnosis.<br>|
| 3) Patients with lone intracranial stenosis.<br>Patients with lone intracranial stenosis. | Other: Carotid duplex+/- MRA neck<br>* Carotid duplex and or MRA neck<br>Other: brain MRA+/-CT angio on carotid and brain<br>* brain MRA and or CT angiography on carotid and brain<br>Other: MRI brain<br>* MRI brain with diffusion to detect asymptomatic stroke<br>Other: DSA (digital subtraction angiography)<br>* DSA (digital subtraction angiography) in some cases to confirm diagnosis.<br>|
| 4) Patients with no significant stenosis<br>Patients with no significant carotid or intracranial stenosis. | Other: Carotid duplex+/- MRA neck<br>* Carotid duplex and or MRA neck<br>Other: brain MRA+/-CT angio on carotid and brain<br>* brain MRA and or CT angiography on carotid and brain<br>Other: MRI brain<br>* MRI brain with diffusion to detect asymptomatic stroke<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| National Institutes of Health Stroke Scale | The National Institutes of Health Stroke Scale is a tool used by healthcare providers to objectively quantify the impairment caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific ability between a 0 and 4. For each item, a score of 0 typically indicates normal function in that specific ability, while a higher score is indicative of some level of impairment. The individual scores from each item are summed in order to calculate a patient's total NIHSS score. The maximum possible score is 42, with the minimum score being a 0. The higher score indicate poor outcome. | 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The modified Rankin Scale | The modified Rankin Scale is a commonly used scale for measuring the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. It has become the most widely used clinical outcome measure for stroke clinical trials. The higher score indicate poor outcome. | 24 hours | 
| Beck's Depression Inventory | The Beck Depression Inventory, created by Aaron T. Beck, is a 21-question multiple-choice self-report inventory, one of the most widely used psychometric tests for measuring the severity of depression. | 24hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ischemic Stroke, carotid stenosis