CARotid plaqUe StabilizatiOn and Regression With Evolocumab.

  • STATUS
    Recruiting
  • End date
    Mar 1, 2022
  • participants needed
    130
  • sponsor
    Azienda Ospedaliera Ordine Mauriziano di Torino
Updated on 4 February 2021

Summary

The CARUSO trial aims at investigating the efficacy of evolocumab in promoting carotid plaque morphological stabilization and regression as compared to traditional lipid lowering therapy (LLT). Primary end-point of the study is the superiority of evolocumab on top of ongoing LLT versus ongoing LLT in carotid plaque morphological stabilization and regression at 6 and 12 months, respectively. Secondary end-points are: LDL-Cholesterol (LDL-C) absolute and percentage changes in the two groups at 12 month follow-up, and adverse cerebrovascular and cardiac events at 12 and 24 months

Description

Optimal lipid-lowering therapy (LLT) is a mainstay for the therapeutic management of atherosclerotic vascular disease. Cardiac and cerebrovascular adverse events and progression of atherosclerosis are, indeed, reduced in proportion to the achieved LDL cholesterol (LDL-C) levels.In addition, regression of atherosclerotic plaques with optimal LLT has been observed. However, optimal LLT with statin and ezetimibe, might be limited by the onset of adverse effects (i.e. disabling myalgias, diarrhea) with are usually dose -dependent, and the maximum tolerated statin dose might be insufficient to reach the recommended LDL-C goals. The advent of proprotein convertase subtilisin kexin type 9 inhibitors (PCSK9i) has allowed the achievement of very low LDL-C levels, and the fulfillment of the recommended LDL-C targets. However, while the experience with PCSK9i in patients with coronary artery disease has been wide, and coronary plaque regression has been documented, little is known regarding carotid plaque regression following therapy with PCSK9i. Only a few case reports have been published, and no observational study has been carried out so far. Furthermore, morphological carotid plaque stabilization has a prognostic role, and the possibility of its early achievement with PCSK9i may be relevant, especially in the context of percutaneous or surgical carotid interventions.

Details
Condition CAROTID ARTERY DISEASE
Treatment Evolocumab, lipid-lowering therapy (LLT)
Clinical Study IdentifierNCT04730973
SponsorAzienda Ospedaliera Ordine Mauriziano di Torino
Last Modified on4 February 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

asymptomatic patients with uni- or bilateral carotid artery stenosis 50% and
LDL-C values 100 mg/dL despite ongoing lipid lowering therapy

Exclusion Criteria

age <18 or 81 years old
known intolerance to evolocumab
ongoing or previous treatment with PCSK9i
prior stroke or transient ischemic attack
total carotid occlusion
major active infection or major hematologic, renal, hepatic, or endocrine dysfunction
malignancy with life expectancy below 24 months
failure to sign informed consent
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