After qualification for the study (by a neurologist and vascular surgeon), patients meeting properly the inclusion and exclusion criteria will be referred for imaging studies with Doppler ultrasound, angio-CT scan of the arteries of the neck and head and cerebral perfusion in magnetic resonanse (assessment of the cerebral perfusion alterations using DSC (dynamic susceptibility contrast).
In addition, blood will be drawn and stored for subsequent testing. Afterwards, patients qualified for internal carotid artery angioplasty procedures will receive standard saturation treatment with two antiplatelet drugs (acetylsalicylic acid, clopidogrel) before the procedure, strictly according to the guidelines. The procedures are carried out with approved medical equipment (carotid stent, angioplasty balloon, peripheral neuroprotection). The selection of the appropriate equipment used for the procedure depends on the clinical situation, the experience of the operator and the anatomical conditions of the carotid arteries.
Measurements (invasive pressure in carotid artery) taken during the procedure before angioplasty (after insertion of the neuroprotection into the internal carotid artery) and after stent implantation:
COURSE OF THE STUDY
Baseline examination:
* Doppler ultrasound of the extracranial cephalic arteries
* initial qualification for CAS /neurologist, vascular surgeon/
* informed consent to participate in the study
* cardiological consultation (modification of risk factors)
* angio-CT of the neck and head
* assessment of the cerebral perfusion alterations using DSC (dynamic susceptibility contrast) MR perfusion
* additional neurological (with questionnaires), psychological (with questionnaires) and otolaryngological examination
* surgery (CAS) - Department of Vascular Surgery, Department of Cardiology
Measurements (invasive pressure) taken during the procedure before angioplasty (after insertion of the neuroprotection into the internal carotid artery) and after stent implantation:
* placement of a micro catheter to measure invasive pressure
* taking a measurement in the internal carotid artery above the stenosis (in the normal section of this artery)
* performing a measurement before the stenosis (in the normal segment of the common carotid artery at the level of the exit of the external carotid artery)
* reading the pressure gradient after obtaining a stable value (a minimum of 5 cardiac cycles)
* The study of intravascular pressure measurements will be performed using a special micro catheter of about 1mm in size (i.e., more than 2 times smaller than the delivery system for distal protection, which is the standard procedure, so the risk of complications is minimal). In the study protocol, the insertion of the catheter and measurement of pressures will be followed by the placement of a neuroprotection device in the distal carotid artery (standard of practice) to avoid possible complications.
Evaluation during treatment:
* angio-CT of the neck and head, 3 month after CAS
* assessment of the cerebral perfusion alterations using DSC (dynamic susceptibility contrast) MR perfusion, 3 month after CAS
* Doppler ultrasound of the extracranial cephalic arteries, 3 and 12 month after CAS
* Neurological (with questionnaires), psychological (with questionnaires) and otolaryngological examination betwenn 10-16 week after CAS
* Cardiological evaluation at 3, 6, 12 month after CAS (modification of risk factors)
