Blood Pressure Clinical Trial
Official title:
Velocity Systolic Blood Pressure Index in Accurately Predicting Cerebral Hyperperfusion Syndrome After Carotid Endarterectomy
Background: Cerebral hyperperfusion syndrome (CHS) is a life threatening complication of
carotid endarterectomy (CEA) and the changes of middle cerebral artery velocity are used to
predict the occurrence of CHS but the accuracy is limited. In addition, changes of BP
post-operatively comparing with baseline BP should be a predictive factor of CHS.
Objective: The investigators aimed to create a predictive index, velocity systolic blood
pressure index (VSI), for improving the predictive power of Transcranial Doppler monitoring
regarding CHS.
Methods: The study design is a diagnostic test, which is an observational analytic clinical
study. From March 2013 to September 2014, 200 patients will be recruited. Patients will be
classified according to the CHS occurrence. VSI combined the changes of middle cerebral
artery velocity and blood pressure crossing CEA and the intra- and post-operative increase
ratios of middle cerebral artery velocity were calculated. Their prediction power of CHS
will be compared. Sensitivity, specificity, positive predictive value, negative predictive
value of them will be calculated. Receiver operating characteristic analysis will be
performed.
Expected Outcomes: Comparing with the commonly used intra-operative and post-operative TCD
monitoring, VSI may be more useful to select CHS in patients who underwent CEA. As far as
the investigators know, analysis or studies combining the BP and velocity changes in the
prediction of CHS have never been performed.
This study is designed as a standard diagnostic test. It is designed to verify the predictive power of VSI with CHS, and which is an observational analytic clinical study. The investigative parameters of patients will be collected prospectively by the designed case report form. According to the incidence of CHS, the estimated enrollment amount is set as 200. Patients will be recruited by the inclusion and exclusion criteria below. All the patients included will accept the standard CEA surgery treatment in the department of vascular surgery of PUMCH. MCAV and systolic BP data will be recorded cross CEA. Post-operatively the CHS patients will be identified according to the golden standard. The golden standard is the clinical diagnose of CHS (the detailed diagnostic criteria will be stated in the methodology part). The TCD operator is blind to the patients. The predictive power of VSI will be identified by the sensitivity, specificity, positive predictive value, negative predictive value and ROC plot comparing with the golden standard. The study start date is March 2013, the estimated study completion date is December 2014 and the primary completion date is September 2014 (final data collection date for primary outcome measure). ;
Observational Model: Cohort, Time Perspective: Prospective
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