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

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.