All occlusion is due to atherosclerotic disease.Increased MTT and/or time to peak (TTP) on CT perfusion as defined as T Max threshold of > 10cc > 4 seconds in the territory of the occluded carotid specifically in the MCA territory when compared to the opposite unaffected hemisphere (not required for observational cohort).Complete occlusion of cervical ICA on imaging studies (MRA or CTA) and confirmed with DSA.DSA is performed at 1 year follow-up for intervention subjects to assess brain bio-markers and revascularization respectively. MRI of the brain and is done at 6 and 12 months. Repeat testing of MoCA and additional cognitive testing battery are done at these clinical follow-up visits (6 and 12 months). Follow up clinic visits are arranged at 6 and 12 months.
#ABNORMAL MOCA SCORE FULL#
If the subject meets all inclusion criteria, then a baseline of complete neurological testing, full demographics, CTA or MRA, CTP, MoCA, additional neurological testing, MRI spectroscopy and DSA are obtained and subject is randomized 1:1 to either best medical management or best medical management + endovascular balloon angioplasty and stenting. If any subject is found to have complete occlusion of COICA, evident of abnormal/prolongation of MTT on CTP, previous history of TIA and or stroke, and MoCA 26 or other neuropsychological assessment, then the subject is excluded and no further testing needed (see exclusion criteria). Screening, Enrolling, & Randomization: All subjects who presents to our tertiary hospital with a diagnosis of COICA will undergo full evaluation including 1) documenting previous history of transient ischemic attack (TIA) and/or stroke 2) cervical and brain CT angiography (CTA) to document complete occlusion 3) CT perfusion (CTP) to assess for presence of penumbra evident by increased mean transient time (MTT) in the ipsilateral side of COICA and 4) Montreal cognitive assessment (MoCA) score. best medical management and endovascular revascularization of COICA.
#ABNORMAL MOCA SCORE TRIAL#
Study Design: Prospective randomized open blinded end-point (PROBE) study This is a phase 2 randomized single-center open label clinical trial with randomization of 1:1 to either best medical management vs.
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