Management of extracranial carotid artery stenosis during endovascular treatment for acute ischaemic stroke: results from the MR CLEAN Registry

• Published in: Stroke and vascular neurology 2023-06, Vol.8 (3), p.229-237
• Main Authors: Collette, Sabine L, Rodgers, Michael P, van Walderveen, Marianne A A, Compagne, Kars C J, Nederkoorn, Paul J, Hofmeijer, Jeannette, Martens, Jasper M, de Borst, Gert J, Luijckx, Gert Jan R, Majoie, Charles B L M, van der Lugt, Aad, Bokkers, Reinoud P H, Uyttenboogaart, Maarten
• Format: Article
• Language: English
• Subjects: Atherosclerosis; Blood clots; Brain Ischemia - diagnostic imaging; Brain Ischemia - etiology; Brain Ischemia - therapy; Carotid arteries; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - therapy; Constriction, Pathologic - etiology; Dissection; Endovascular Procedures - adverse effects; Hemorrhage; Humans; Ischemia; Ischemic Stroke - diagnostic imaging; Ischemic Stroke - etiology; Ischemic Stroke - therapy; Laboratories; Medical imaging; Observational studies; Original Research; Patients; Registries; Stents; Stroke; Stroke - diagnostic imaging; Stroke - etiology; Stroke - therapy; Veins & arteries
• ISSN: 2059-8688; 2059-8696
• DOI: 10.1136/svn-2022-001891

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). 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. 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). 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.