{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:25:19Z","timestamp":1787030719983,"version":"build-2736575974"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Self-initiated Research Project of General Hospital of the Northern Theater Command","award":["ZZKY2024014"],"award-info":[{"award-number":["ZZKY2024014"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"\n Background<\/jats:title>\n Carotid artery stenting (CAS) is an effective revascularization procedure for internal carotid artery stenosis, but it is associated with a high incidence of perioperative cerebral embolism, with asymptomatic and symptomatic embolic events occurring in up to 40% of patients. Transcranial Doppler (TCD) has been shown to enhance fibrinolysis through sonothrombolysis and may reduce embolic burden during carotid interventions.<\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n To evaluate whether intraoperative and post-procedural TCD monitoring can reduce the number of new diffusion-weighted imaging (DWI) lesions after CAS in patients with severe internal carotid artery stenosis.<\/jats:p>\n <\/jats:sec>\n \n Sample size estimates<\/jats:title>\n \n A total of 232 patients are required to detect a 50% reduction in the median number of new DWI lesions (from 2.0 to 1.0) with 80% power and a two-sided\n \u03b1<\/jats:italic>\n of 0.05, accounting for a 5% dropout rate.\n <\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n TCD-ICAS is a prospective, randomized, single-center, blinded endpoint trial. Patients scheduled for CAS are randomized 1:1 to receive either TCD treatment (1.6\u202fMHz, 0.274\u202fMPa) from femoral artery puncture until 30\u201360\u202fmin after procedure completion plus standard care, or standard care alone.<\/jats:p>\n <\/jats:sec>\n \n Outcomes<\/jats:title>\n The primary efficacy endpoint is the number of new DWI lesions at 24\u202fh post-randomization. The primary safety endpoint is intracranial hemorrhage within 24\u202fh.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The TCD-ICAS trial will assess the efficacy and safety of TCD as an adjuvant therapy to reduce cerebral embolic events in patients undergoing CAS.<\/jats:p>\n <\/jats:sec>\n \n Clinical trial registration<\/jats:title>\n Identifier (NCT07462546).<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fneur.2026.1843954","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:29:15Z","timestamp":1787027355000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Transcranial Doppler for internal carotid artery stenting: rationale and design of a randomized controlled trial"],"prefix":"10.3389","volume":"17","author":[{"given":"Yan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Neurology, General Hospital of Northern Theater Command","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying-Jia","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, General Hospital of Northern Theater Command","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, General Hospital of Northern Theater Command","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting-Ting","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, General Hospital of Northern Theater Command","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui-Sheng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, General Hospital of Northern Theater Command","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1007\/s00270-024-03707-y","article-title":"CIRSE standards of practice on carotid artery stenting","volume":"47","author":"Spiliopoulos","year":"2024","journal-title":"Cardiovasc Intervent Radiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1016\/j.jvs.2025.09.039","article-title":"An international, expert-based, multispecialty Delphi consensus document on stroke risk stratification and the optimal management of patients with asymptomatic and symptomatic carotid stenosis","volume":"83","author":"Paraskevas","year":"2026","journal-title":"J Vasc Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1056\/NEJMoa2508800","article-title":"Medical management and revascularization for asymptomatic carotid 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