Selective Coronary Revascularization in Carotid Artery Disease Patients After Carotid Revascularization (SCORECAD Trial)
Pauls Stradins Clinical University Hospital
300 participants
Jun 25, 2024
OBSERVATIONAL
Conditions
Summary
The primary objective of this study is to determine whether among symptomatic and asymptomatic carotid artery stenosis (CAS) patients with no known coronary artery disease (CAD) who had undergone carotid artery revascularization (endarterectomy of stenting) a strategy of best medical therapy (BMT) plus selective coronary revascularization based on FFRct assessment of lesion-specific coronary ischemia can reduce adverse cardiac events and improve survival compared to BMT alone. Lesion-specific coronary ischemia is defined as FFRCT ≤0.80 distal to stenosis in a major (≥2 mm) coronary artery with severe ischemia defined as FFRCT ≤0.75.
Eligibility
Inclusion Criteria3
- Inform consent obtained before any study-related activities;
- Age above or equal to 50 years with symptomatic or asymptomatic critical carotid stenosis (symptomatic patients with at least Rankin III) which has been successfully revascularized by carotid endarterectomy or stenting within the past 14 days;
- Willing and able to undergo coronary CTA scan within 14 days of randomization and agrees to submission of CTA data set for HeartFlow FFRct analysis with results made available to treating physician.
Exclusion Criteria16
- Known CAD, history of MI, prior coronary revascularization (PCI or CABG);
- Patient underwent coronary angiography or coronary CTA before the randomization;
- Known history of 2nd or 3rd degree heart block; sick sinus syndrome; long QT syndrome;
- History of severe asthma, severe or bronchodilator-dependent Chronic obstructive pulmonary disease (COPD);
- Severe congestive heart failure (NYHA III or IV);
- Severe arrhythmia, prior pacemaker or internal defibrillator lead implantation;
- Impaired chronic renal function (EPI-GFR<30ml/min);
- Subjects with known anaphylactic allergy to iodinated contrast;
- Pregnancy or unknown pregnancy status in subject of childbearing potential;
- Evidence of ongoing or active clinical instability, including acute chest pain (sudden onset), cardiogenic shock, unstable blood pressure with systolic blood pressure <90 mmHg, or acute pulmonary edema;
- Any active, serious, life-threatening disease with a life expectancy of less than 2 years;
- Any active infection;
- Inability to comply with study procedures;
- Contraindication for guideline-guided long-term antiplatelet/anticoagulation regime after PCI/CABG;
- Large neurologic deficit (Rankin scale >III);
- Participation in any interventional clinical study within 30 days prior to screening.
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Interventions
A new non-invasive cardiac diagnostic test, coronary CT-derived fractional flow reserve (FFRCT) provides a unified anatomic and functional assessment of coronary artery disease which can reliably identify ischemia-producing coronary lesions. FFRCT accurately reflects invasively measured FFR and can help guide patient management and coronary revascularization decisions.
Locations(1)
View Full Details on ClinicalTrials.gov
For the most up-to-date information, visit the official listing.
NCT06546761