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

Collette, S.L.; Rodgers, M.P.; Walderveen, M.A.A. van; Compagne, K.C.J.; Nederkoorn, P.J.; Hofmeijer, J.; ... ; MR CLEAN Registry Investigators (2022)

Article / Letter to editor

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.

• Stents
• Stroke
• Thrombectomy
• Atherosclerosis
• Carotid Stenosis

• All authors: Collette, S.L.; Rodgers, M.P.; Walderveen, M.A.A. van; Compagne, K.C.J.; Nederkoorn, P.J.; Hofmeijer, J.; Martens, J.M.; Borst, G.J. de; Luijckx, G.J.R.; Majoie, C.B.L.M.; Lugt, A. van der; Bokkers, R.P.H.; Uyttenboogaart, M.; MR CLEAN Registry Investigators
• Date: 2022-12-26
• Journal: Stroke and Vascular Neurology
• Volume: 8
• Issue: 3
• DOI: doi:10.1136/svn-2022-001891