RT Journal Article
SR Electronic
T1 Management of extracranial carotid artery stenosis during endovascular treatment for acute ischaemic stroke: results from the MR CLEAN Registry
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 229
OP 237
DO 10.1136/svn-2022-001891
VO 8
IS 3
A1 Collette, Sabine L
A1 Rodgers, Michael P
A1 van Walderveen, Marianne A A
A1 Compagne, Kars C J
A1 Nederkoorn, Paul J
A1 Hofmeijer, Jeannette
A1 Martens, Jasper M
A1 de Borst, Gert J
A1 Luijckx, Gert Jan R
A1 Majoie, Charles B L M
A1 van der Lugt, Aad
A1 Bokkers, Reinoud P H
A1 Uyttenboogaart, Maarten
A1 
YR 2023
UL http://svn.bmj.com/content/8/3/229.abstract
AB Background The optimal management of ipsilateral extracranial internal carotid artery (ICA) stenosis during endovascular treatment (EVT) is unclear. We compared the outcomes of two different strategies: EVT with vs without carotid artery stenting (CAS).Methods In this observational study, we included patients who had an acute ischaemic stroke undergoing EVT and a concomitant ipsilateral extracranial ICA stenosis of ≥50% or occlusion of presumed atherosclerotic origin, from the Dutch Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry (2014–2017). The primary endpoint was a good functional outcome at 90 days, defined as a modified Rankin Scale score ≤2. Secondary endpoints were successful intracranial reperfusion, new clot in a different vascular territory, symptomatic intracranial haemorrhage, recurrent ischaemic stroke and any serious adverse event.Results Of the 433 included patients, 169 (39%) underwent EVT with CAS. In 123/168 (73%) patients, CAS was performed before intracranial thrombectomy. In 42/224 (19%) patients who underwent EVT without CAS, a deferred carotid endarterectomy or CAS was performed. EVT with and without CAS were associated with similar proportions of good functional outcome (47% vs 42%, respectively; adjusted OR (aOR), 0.90; 95% CI, 0.50 to 1.62). There were no major differences between the groups in any of the secondary endpoints, except for the increased odds of a new clot in a different vascular territory in the EVT with CAS group (aOR, 2.96; 95% CI, 1.07 to 8.21).Conclusions Functional outcomes were comparable after EVT with and without CAS. CAS during EVT might be a feasible option to treat the extracranial ICA stenosis but randomised studies are warranted to prove non-inferiority or superiority.No data are available. Data will not be made available to other researchers as no patient approval has been obtained for sharing data. Syntax files will be made available from the corresponding author on reasonable request.