Management of extracranial carotid artery stenosis during endovascular treatment for acute ischaemic stroke: results from the MR CLEAN Registry (2024)

Collette, S. L., Rodgers, M. P., Van Walderveen, M. A. A., Compagne, K. C. J., Nederkoorn, P. J., Hofmeijer, J., Martens, J. M., De Borst, G. J., Luijckx, G. J. R., Majoie, C. B. L. M., Van Der Lugt, A., Bokkers, R. P. H., Uyttenboogaart, M., & MR CLEAN Registry Investigators (2023). Management of extracranial carotid artery stenosis during endovascular treatment for acute ischaemic stroke: results from the MR CLEAN Registry. Stroke and Vascular Neurology, 8(3), 229-237. https://doi.org/10.1136/svn-2022-001891

Collette, Sabine L. ; Rodgers, Michael P. ; Van Walderveen, Marianne A.A. et al. / Management of extracranial carotid artery stenosis during endovascular treatment for acute ischaemic stroke : results from the MR CLEAN Registry. In: Stroke and Vascular Neurology. 2023 ; Vol. 8, No. 3. pp. 229-237.

@article{f7fd22c4eb684a3a8d4cce4b64e78804,

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

abstract = "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.",

keywords = "Atherosclerosis, Carotid Stenosis, Stents, Stroke, Thrombectomy",

author = "Collette, {Sabine L.} and Rodgers, {Michael P.} and {Van Walderveen}, {Marianne A.A.} and Compagne, {Kars C.J.} and Nederkoorn, {Paul J.} and Jeannette Hofmeijer and Martens, {Jasper M.} and {De Borst}, {Gert J.} and Luijckx, {Gert Jan R.} and Majoie, {Charles B.L.M.} and {Van Der Lugt}, Aad and Bokkers, {Reinoud P.H.} and Maarten Uyttenboogaart and {MR CLEAN Registry Investigators}",

note = "Funding Information: The MR CLEAN Registry was partly funded by Toegepast Wetenschappelijk Instituut voor Neuromodulatie (TWIN) Foundation, Erasmus MC University Medical Centre, Maastricht University Medical Centre and Amsterdam University Medical Centre. Funding Information: Amsterdam University Medical Centre received funds from Stryker for consultations by Professor Dr Majoie, Professor Dr Roos and Dr Berkhemer. Maastricht University Medical Centre received funds from Stryker and Codman for consultations by Professor Dr Van Zwam. Dr Nederkoorn: Grants from CVON/Dutch Heart Foundation and Netherlands Organization of Scientific Research. Professor Dr Majoie: Related: Grants TWIN Foundation; Unrelated: Grants from CVON/Dutch Heart Foundation, Stryker, European Commission, TWIN Foundation, Health Evaluation Netherlands (all paid to institution); shareholder of Nico-lab, a company that focuses on the use of artificial intelligence for medical image analysis (modest). Professor Dr Van der Lugt: Grants from CVON/Dutch Heart Foundation, Dutch Brain Foundation, European Commission, Stryker, Medtronic, Penumbra, Cerenovus, Philips, GE Healthcare, Philips Healthcare all paid to institution. The other authors have no conflicts of interest to declare. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ",

year = "2023",

month = jun,

doi = "10.1136/svn-2022-001891",

language = "English",

volume = "8",

pages = "229--237",

journal = "Stroke and Vascular Neurology",

issn = "2059-8688",

publisher = "BMJ",

number = "3",

}

Collette, SL, Rodgers, MP, Van Walderveen, MAA, Compagne, KCJ, Nederkoorn, PJ, Hofmeijer, J, Martens, JM, De Borst, GJ, Luijckx, GJR, Majoie, CBLM, Van Der Lugt, A, Bokkers, RPH, Uyttenboogaart, M & MR CLEAN Registry Investigators 2023, 'Management of extracranial carotid artery stenosis during endovascular treatment for acute ischaemic stroke: results from the MR CLEAN Registry', Stroke and Vascular Neurology, vol. 8, no. 3, pp. 229-237. https://doi.org/10.1136/svn-2022-001891

Management of extracranial carotid artery stenosis during endovascular treatment for acute ischaemic stroke: results from the MR CLEAN Registry. / Collette, Sabine L.; Rodgers, Michael P.; Van Walderveen, Marianne A.A. et al.
In: Stroke and Vascular Neurology, Vol. 8, No. 3, 06.2023, p. 229-237.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Management of extracranial carotid artery stenosis during endovascular treatment for acute ischaemic stroke

T2 - results from the MR CLEAN Registry

AU - Collette, Sabine L.

AU - Rodgers, Michael P.

AU - Van Walderveen, Marianne A.A.

AU - Compagne, Kars C.J.

AU - Nederkoorn, Paul J.

AU - Hofmeijer, Jeannette

AU - Martens, Jasper M.

AU - De Borst, Gert J.

AU - Luijckx, Gert Jan R.

AU - Majoie, Charles B.L.M.

AU - Van Der Lugt, Aad

AU - Bokkers, Reinoud P.H.

AU - Uyttenboogaart, Maarten

AU - MR CLEAN Registry Investigators

N1 - Funding Information:The MR CLEAN Registry was partly funded by Toegepast Wetenschappelijk Instituut voor Neuromodulatie (TWIN) Foundation, Erasmus MC University Medical Centre, Maastricht University Medical Centre and Amsterdam University Medical Centre. Funding Information:Amsterdam University Medical Centre received funds from Stryker for consultations by Professor Dr Majoie, Professor Dr Roos and Dr Berkhemer. Maastricht University Medical Centre received funds from Stryker and Codman for consultations by Professor Dr Van Zwam. Dr Nederkoorn: Grants from CVON/Dutch Heart Foundation and Netherlands Organization of Scientific Research. Professor Dr Majoie: Related: Grants TWIN Foundation; Unrelated: Grants from CVON/Dutch Heart Foundation, Stryker, European Commission, TWIN Foundation, Health Evaluation Netherlands (all paid to institution); shareholder of Nico-lab, a company that focuses on the use of artificial intelligence for medical image analysis (modest). Professor Dr Van der Lugt: Grants from CVON/Dutch Heart Foundation, Dutch Brain Foundation, European Commission, Stryker, Medtronic, Penumbra, Cerenovus, Philips, GE Healthcare, Philips Healthcare all paid to institution. The other authors have no conflicts of interest to declare. Publisher Copyright:© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2023/6

Y1 - 2023/6

N2 - 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.

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.

KW - Atherosclerosis

KW - Carotid Stenosis

KW - Stents

KW - Stroke

KW - Thrombectomy

UR - http://www.scopus.com/inward/record.url?scp=85164042255&partnerID=8YFLogxK

U2 - 10.1136/svn-2022-001891

DO - 10.1136/svn-2022-001891

M3 - Article

C2 - 36572506

AN - SCOPUS:85164042255

SN - 2059-8688

VL - 8

SP - 229

EP - 237

JO - Stroke and Vascular Neurology

JF - Stroke and Vascular Neurology

IS - 3

ER -

Collette SL, Rodgers MP, Van Walderveen MAA, Compagne KCJ, Nederkoorn PJ, Hofmeijer J et al. Management of extracranial carotid artery stenosis during endovascular treatment for acute ischaemic stroke: results from the MR CLEAN Registry. Stroke and Vascular Neurology. 2023 Jun;8(3):229-237. Epub 2022 Dec 26. doi: 10.1136/svn-2022-001891