Carotid Stenosis
Conditions
Keywords
Carotid Artery Stenting, Sinus Reflex, Antihypertensive drugs, Catecholamine
Brief summary
Carotid artery stenting (CAS) is one of major treatments in prevention of ischemic stroke. Because of sinus reflex due to stenting and balloon dilatation, persistent post-surgery hypotension is a common perioperative event. Persistent hypotension can lead to perioperative adverse events like ischemic stroke, myocardial infraction, renal failure and death; or more usually, it prolongs length of stay and hospital expenses. Renin-angiotensin-aldosterone inhibitor (RASI) could inhibit the release of catecholamine and may lead to higher rate of persistent hypotension after CAS compared to other hypertensives.Thus, the investigators aim to investigate the effect of pre-operation antihypertensive drugs on persistent hypotension after stenting, and followed burden in carotid artery stenting comorbid with hypertension patients.
Interventions
DRUGadministering RASI (the trade name or universal name will not be stipulated) before stenting
Pre-operative antihypertensive drugs before stenting will be random assigned (RASI or CCB) at least 5 days before stenting. Patients in RASI group will receive RASI (all kinds of RASI will be permited and the trade name or universal name of drugs will not be limited), with or without other antihypertensives except for CCB (any kind of CCB). Blood pressure of patients should be controlled within the target range (140/90 mmHg); and usage and dosage of antihypertensive drugs will not be stipulated. Grapefruit intaking should be avoid.
DRUGadministering CCB (the trade name or universal name will not be stipulated) before stenting
Pre-operative antihypertensive drugs before stenting will be random assigned (RASI or CCB) at least 5 days before stenting. Patients in CCB group will receive CCB (all kinds of CCB will be permited and the trade name or universal name of drugs will not be limited), with or without other antihypertensives except for RASI (any kind of RASI). Blood pressure of patients should be controlled within the target range (140/90 mmHg); and usage and dosage of antihypertensive drugs will not be stipulated. Grapefruit intaking should be avoid.
Sponsors
West China Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Masking description
open label, blinded endpoint
Intervention model description
RASI group and CCB group
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* age ≥ 18 * have a history of TIA or nondisabling ischemic stroke within the past 6 months (symptomatic) with ipsilateral initial part of EICA stenosis ≥ 50 % or asymptomatic with initial part of EICA stenosis ≥ 70%, and the cause of stenosis was atherosclerosis * have hypertension requiring hypertensives * modified Rankin scale (mRS) before stenting \< 3
Exclusion criteria
* with ipsilateral tandem stenosis * with history of operation in contralateral carotid artery, like stenting, endarterectomy and bypass. * requiring operation in contralateral carotid artery in the same admission. * requiring general anesthesia in the same operation (stenting) * with contraindication to carotid stenting, such as Inability to tolerate surgery due to organ dysfunction, cerebral aneurism, cerebral hemorrhage in 3 months, myocardial infraction or large-area cerebral infraction within 2 weeks, extreme tortuosity of the vessel * allergic to Calcium channel blockers, angiotensin receptor blockers or hydrochlorothiazide * pregnancy * with concomitant medication as following: Azole antifungals, macrolides antibiotics, cardiac calcium channel blockers, Rifampicin, sildenafil, simvastatin, immunosuppressants, antidepressants, valproic acid, cimetidine, aliskiren, NSAIDs, protease inhibitors (ritonavir) and drugs that affect potassium in the blood * with hepatic insufficiency, renal insufficiency, kidney transplantation, diabetic nephropathy, biliary obstructive disease, or the presence of end-stage disease affecting clinical prognosis assessment (such as end-stage cancer, end-stage heart disease, liver failure, renal failure, pulmonary failure) * with depression, schizophrenia, bipolar disorder, epilepsy, tuberculosis, AIDS, primary hyperaldosteronism, hyperkalemia, hypercalcemia, hyperuricemia, gout * participating other trails which would affect the evaluation of outcomes * with reserpine and clonidine intake within 1 week
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The incidence of persistent post-surgery hypotension | the first 24 hours after CAS | systolic blood pressure (SBP) \< 90 mmHg or requiring vasopressor with lasting \> 6 hours, and without evidence hypovolemia and heart failure |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Length of stay after surgery | From surgery to dicharge, up to 3 month. | — |
| Hospital expenses after surgery, based on payment list in hospital information system | From surgery to dicharge, up to 3 month. | Payment list in hospital information system for all patients will be recorded with permission and the hospital expenses after surgery will be caculated based on those records. |
| Difference of serum catecholamine (adrenalin, norepinephrine and dopamine) before and after surgery (all in unit of nmol/L) | at morning (7 o'clock am) of the day of surgery and the first day after surgery | — |
| The incidence of bradycardia after surgery | the first 24 hours after CAS | — |
| The total incidence of stroke, myocardial infraction, renal failure and embolism of retinal arteries | From surgery to dicharge, up to 3 month. | — |
| Difference of heart rate variability (HRV) before and after surgery | 24 hours before surgery to at least 24 hours after surgery | — |
Other
| Measure | Time frame |
|---|---|
| The total incidence of cardiac and cerebral events (stroke, myocardial infarction, heart failure and angina pectoris) and symptomatic hypotension | From administering antihypertensive drugs to stenting, at least 5 days |
Countries
China
Contacts
Primary ContactBo Wu, Dr
Outcome results
None listed