Endovascular Thrombectomy for Extracranial Internal Carotid Artery Occlusions With Large Ischemic Strokes

Background and Objectives Although previous trials have established the efficacy and safety of endovascular thrombectomy (EVT) in large ischemic core strokes, most of them excluded patients with extracranial internal carotid artery (e-ICA) occlusion. We aimed to compare outcomes in patients with e-ICA occlusion and large ischemic core infarcts treated with EVT vs medical management (MM). Methods This was a secondary analysis of the SELECT2 trial, a randomized controlled trial conducted at 31 international sites. Adult patients with proximal intracranial anterior circulation large ischemic strokes, defined as Alberta Stroke Program Early CT Score (ASPECTS) 3–5 on noncontrast CT or ischemic core ≥50 mL on CT-perfusion/magnetic resonance-diffusion imaging, and concomitant e-ICA occlusion were selected. The primary outcomes were the distribution of modified Rankin Scale (mRS) score at 90-day follow-up and symptomatic intracranial hemorrhage (sICH). Results Among 352 enrolled patients, 62 (17.6%) with e-ICA occlusions were included. Of those 62 patients, 37 received EVT (median [interquartile range (IQR)] age, 65 [58–71] years; 15 women Glossary aGenOR = adjusted generalized odds ratio; AIS = acute ischemic stroke; ANGEL-ASPECT = Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core; aRR = adjusted relative ratio; ASPECTS = Alberta Stroke Program Early CT Score; CAS = carotid artery stenting; e-ICA = extracranial internal carotid artery; ETIS = Endovascular Treatment in Ischemic Stroke; EVT = endovascular thrombectomy; HT = hemorrhagic transformation; IQR = interquartile range; LVO = large vessel occlusion; MCA = middle cerebral artery; MM = medical management; MR = magnetic resonance; mRS = modified Rankin scale; NIHSS = NIH Stroke Scale; PH1 = parenchymal hemorrhage type 1; PH2 = parenchymal hemorrhage type 2; PIM = probabilistic index model; RCT = randomized controlled trial; sICH = symptomatic intracranial hemorrhage.