Article Figures & Data
- Figure 1
Flowchart of included patients. CAS, carotid artery stenting; CEA, carotid endarterectomy; CTA, CT angiography; DSA, digital subtraction angiography; EVT, endovascular treatment; ICA, internal carotid artery; MR CLEAN, Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; mRS, modified Rankin Score; PTA, percutaneous transluminal angioplasty.
- Figure 2
Functional outcome at 90 days of EVT with and without CAS patients. The data in this figure are based on the data set before imputation. CAS, carotid artery stenting; EVT, endovascular treatment; mRS, modified Rankin Scale.
- Table 1
Baseline characteristics of EVT with and without CAS patients
Characteristics EVT with CAS (n=169) EVT without CAS (n=264) P value Age - years 70 (63–77) 72 (64–79) 0.04 Male 120/169 (71) 166/264 (63) 0.08 Medical history Atrial fibrillation 11/168 (6.5) 45/261 (17.2) <0.01 Diabetes mellitus 22/167 (13.2) 40/260 (15.4) 0.53 Hypercholesterolaemia 64/167 (38.3) 71/249 (28.5) 0.04 Hypertension 83/166 (50.0) 139/259 (53.7) 0.46 Myocardial infarction 12/166 (7.2) 44/260 (16.9) <0.01 Peripheral artery disease 25/167 (15.0) 32/261 (12.3) 0.42 Previous stroke 20/168 (11.9) 38/261 (14.6) 0.43 Current smoker 65/140 (46.4) 69/190 (36.3) 0.06 Current medication use Antiplatelet 44/166 (26.5) 81/260 (31.2) 0.30 DOAC 2/168 (1.2) 4/259 (1.5) >0.99 Coumarin 8/168 (4.8) 34/262 (13.0) 0.01 Heparin 0/167 (0) 6/259 (2.3) 0.09 Antihypertensive medication 81/166 (48.8) 145/256 (56.6) 0.11 Statin 58/165 (35.2) 94/258 (36.4) 0.79 Pre-stroke mRS score >0 28/165 (17.0) 56/255 (22.0) 0.21 Left hemisphere 86/169 (50.9) 145/264 (54.9) 0.41 Ipsilateral extracranial ICA lesion Carotid stenosis 50–99% 68/169 (40.2) 130/264 (49.2) 0.07 Carotid occlusion 101/169 (59.8) 134/264 (50.8) 0.07 NIHSS score 16 (11–19) 16 (12–19) 0.68 ASPECTS 8 (7–10) 9 (7–10) 0.87 Collateral filling <0.01 Absent collaterals 3/161 (1.9) 22/255 (8.6) <50% of occluded territory 48/161 (29.8) 99/255 (38.8) 50–99% of occluded territory 73/161 (45.3) 94/255 (36.9) 100% of occluded territory 37/161 (23.0) 40/255 (15.7) Intravenous thrombolysis 150/168 (89.3) 214/262 (81.7) 0.03 Pre-intervention DBP - mm Hg 82±16 83±15 0.92 Pre-intervention SBP - mm Hg 154±26 154±23 >0.99 Data are presented as n (%), mean±SD or median (IQR). The data in this table are based on the data set before imputation. For some variables, the denominators are smaller than the number of patients included due to missing data.
ASPECTS, Alberta Stroke Programme Early CT Score; CAS, carotid artery stenting; DBP, diastolic blood pressure; DOAC, direct oral anticoagulants; EVT, endovascular treatment; ICA, internal carotid artery; mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke; SBP, systolic blood pressure.
- Table 2
Procedural characteristics of EVT with and without CAS patients
Characteristics EVT with CAS (n=169) EVT without CAS (n=264) P value EVT technique, first attempt 0.07 Stent retriever 80/169 (47.3) 174/264 (65.9) Aspiration 52/169 (30.8) 69/264 (26.1) Intra-arterial thrombolytics 0/169 (0) 1/264 (0.4) Unknown 37/169 (21.9) 20/264 (7.6) EVT technique, second attempt 0.28 Stent retriever 16/43 (37.2) 26/61 (42.6) Aspiration 20/43 (46.5) 31/61 (50.8) Intra-arterial thrombolytics 7/43 (16.3) 4/61 (6.6) PTA performed 78/168 (46.4) 50/262 (19.1) <0.001 Stenting before EVT 123/168 (73.2) N/A Procedural stent occlusion 7/111 (6.3) N/A Time from onset to arterial puncture - min 190 (141–242) 195 (155–245) 0.55 Time from onset to recanalisation - min 268 (212–330) 260 (213–315) 0.42 Data are presented as n (%) or median (IQR). The data in this table are based on the data set before imputation. For some variables, the denominators are smaller than the number of patients included due to missing data.
CAS, carotid artery stenting; EVT, endovascular treatment; N/A, not applicable; PTA, percutaneous transluminal angioplasty.
- Table 3
Secondary endpoints in EVT with and without CAS patients
Endpoint EVT with CAS
(n=169)EVT without CAS
(n=264)OR 95% CI aOR* 95% CI Successful intracranial reperfusion† 101/164 (61.6) 164/256 (64.1) 0.91 0.60 to 1.36 0.73 0.43 to 1.23 New clot in different vascular territory‡ 14/154 (9.1) 13/241 (5.4) 1.81 0.84 to 3.92 2.96 1.07 to 8.21 Symptomatic intracranial haemorrhage§ 8/169 (4.7) 20/264 (7.6) 0.61 0.26 to 1.41 0.73 0.23 to 2.37 Recurrent ischaemic stroke¶ 3/169 (1.8) 2/264 (0.8) 2.37 0.39 to 14.32 ** Any serious adverse event†† 72/169 (42.6) 99/264 (37.5) 1.24 0.83 to 1.83 1.27 0.76 to 2.11 Data are presented as n (%). The data in this table are partly based on the data set before imputation (number of patients). For some variables, the denominators are smaller than the number of patients included due to missing data.
*Results were adjusted for age, sex, a medical history of atrial fibrillation, hypercholesterolaemia and myocardial infarction, smoking, antiplatelet use, coumarin use, National Institutes of Health Stroke Scale score at baseline, Alberta Stroke Programme Early CT Score, collateral score, intravenous thrombolysis, time from onset to recanalisation and percutaneous transluminal angioplasty during endovascular treatment.
†Successful intracranial reperfusion was defined as extended Thrombolysis In Cerebral Infarction score of ≥2B.
‡New clot in a different vascular territory was defined as a remaining proximal intracranial occlusion on last digital subtraction angiography run that did not match the thrombus locations scored on baseline CT angiography, and had changed either from one territory to another or from a distal occlusion location to a more proximal location.
§An intracranial haemorrhage was considered to be symptomatic if patients died or deteriorated neurologically (a decline of at least 4 points on the National Institutes of Health Stroke Scale) and the haemorrhage was related to the clinical deterioration (according to the Heidelberg criteria).
¶Recurrent ischaemic stroke was defined as a new ischaemic stroke that was confirmed on imaging, led to corresponding neurological deficits or resulted in death.
**The aOR could not be reliably determined due to the limited number of observations of recurrent ischaemic stroke.
††Any serious adverse event was defined as any untoward medical occurrence or effect causing mortality, a life-threatening situation, prolonged hospitalisation or persistent significant disability.
(a)OR, (adjusted) OR; CAS, carotid artery stenting; EVT, endovascular treatment.
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