Reducing Stenosis Risk - The use of dynamic plaque indices to predict risk in (a)symptomatic carotid artery stenosis

Principal Investigator: Professor Tom Robinson

Other key staff: Mr M Brown, Professor D H Evans, Dr A K Mistri, Professor A R Naylor, Professor R B Panerai, Dr K Ramnarine, Dr M Salem, Professor R D Sayers

Partner involved: University Hospitals of Leicester NHS Trust

Summary: Stroke is the third leading cause of mortality, accounting for 11% of all deaths in England and Wales. It is also the commonest cause of long-term disability. Effective hyperacute therapy, such as intravenous thrombolysis, is applicable to the minority of stroke patients. Therefore, preventing future disabling or fatal stroke in people with transient ischaemic attack (TIA) or minor (non-disabling) stroke is an important strategy to reduce subsequent morbidity and mortality.

The study will identify 175 patients undergoing carotid endarterectomy for asymptomatic (35 patients) and symptomatic (140 patients) stenosis from the University Hospitals of Leicester. Non-invasive imaging techniques to assess carotid plaque dynamics will be added to standard criteria. The implementation of this revised risk assessment including carotid plaque dynamics, into the existing one-stop service will be evaluated.

Aims:

• To identify parameters from clinical evaluation and specialised, non-invasive cardiovascular and cerebrovascular assessments to refine existing risk stratification tools
• To incorporate the assessment of dynamic duplex ultrasonography and image normalised grey-scale median analysis into the routine clinical evaluation of TIA and minor ischaemic stroke patients
• To study the frequency and characteristics of micro-embolic signals in a large group of TIA and minor ischaemic stroke patients
• To incorporate differences in gene expression in unstable compared to stable carotid plaques as markers that can be used for the characterisation of patients with carotid atherosclerotic disease which can be related to clinical measures of instability and new duplex ultrasound imaging techniques
• To evaluate a new risk stratification tool based on clinical and laboratory factors for recurring disabling and fatal ischaemic stroke in people with a high risk of TIA and minor ischaemic stroke

Further information: It is intended that patient and carer representatives will be invited to study meetings. If you would like to be involved in this study, or for more information please contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it , Early Detection Theme Manager

Start date: 08/2010                                                                                                     Expected end date: 03/2012

Study outcomes:

• Outcomes will include time between symptom onset and surgery, 30-day postoperative mortality and morbidity, recurrent TIA/ stroke rates and other vascular outcomes

It is hoped this study will inform a future intervention trial to deliver a cost effective secondary prevention strategy, including carotid intervention, to reduce the risk of future disabling stroke and other major cardiovascular events in patients with asymptomatic and symptomatic carotid artery disease.