TY - JOUR
T1 - Endovascular Acute Stroke Intervention–Tandem Occlusion (EASI-TOC) study
T2 - protocol and rationale
AU - Mendes, George N.
AU - Jacquin, Grégory
AU - Iancu, Daniela
AU - Roy, Daniel
AU - Yu, Michael
AU - Bodson-Clermont, Paule
AU - Fahmi, Imene
AU - Ahmed, Syed Uzair
AU - Almekhlafi, Mohammed
AU - Buck, Brian
AU - Camden, Marie Christine
AU - Catanese, Luciana
AU - Diestro, Danni
AU - Fahed, Robert
AU - Field, Thalia S.
AU - Guest, Will
AU - Hawkes, Christine
AU - Hill, Michael D.
AU - Kelly, Michael E.
AU - Kim, Cha Ney
AU - Legault, Catherine
AU - Milot, Geneviève
AU - Moreau, François
AU - Muccilli, Alexandra
AU - Rempel, Jeremy
AU - Shamy, Michel
AU - Singh, Ravinder Jeet
AU - Van Adel, Brian A.
AU - Volders, David
AU - Shankar, Jai
AU - Singh, Nishita
AU - Stapf, Christian
AU - Poppe, Alexandre Y.
N1 - Publisher Copyright:
© The Author(s) 2026. Published by Oxford University Press on behalf of the European Stroke Organisation.
PY - 2026/4
Y1 - 2026/4
N2 - Background: Patients with stroke due to symptomatic intracranial occlusion and concurrent symptomatic high-grade cervical internal carotid artery (ICA) stenosis (≥70%) or occlusion constitute 15%–20% of patients undergoing EVT. The optimal management of the cervical ICA in these tandem lesions remains unknown. We hypothesise that acute carotid artery stenting in addition to EVT will improve functional outcomes when compared with EVT alone. Study design: Endovascular Acute Stroke Intervention–Tandem Occlusion (EASI-TOC) is a multicentre, prospective, randomised, open-label, blinded end-point (PROBE) controlled trial. Adult patients with a disabling acute anterior circulation stroke (intracranial carotid, M1 or M2 segment occlusion) and salvageable brain tissue who undergo EVT within 24 h of onset, are eligible for enrolment if they have an angiographically confirmed atherosclerotic carotid tandem lesion. Patients are randomised 1:1 to acute carotid stenting or no stenting during EVT. Study endpoints: The primary outcome is the proportion of patients achieving a favourable functional outcome (mRS 0–2) at 90 days. Secondary outcomes include 12-month mRS, recanalisation, the 90-day rate of recurrent ipsilateral stroke or retinal ischaemia, the proportion of patients with ICA thrombosis, 90-day Montreal Cognitive Assessment score and quality of life. Safety outcomes include any ICH, sICH, all-cause mortality and procedural complications. Summary: Endovascular Acute Stroke Intervention—Tandem Occlusion is a pragmatic trial addressing a critical gap in the acute management of patients with tandem carotid lesions by evaluating whether acute carotid stenting provides a functional benefit over no stenting in patients undergoing EVT. Trial registration: ClinicalTrials.gov NCT04261478.
AB - Background: Patients with stroke due to symptomatic intracranial occlusion and concurrent symptomatic high-grade cervical internal carotid artery (ICA) stenosis (≥70%) or occlusion constitute 15%–20% of patients undergoing EVT. The optimal management of the cervical ICA in these tandem lesions remains unknown. We hypothesise that acute carotid artery stenting in addition to EVT will improve functional outcomes when compared with EVT alone. Study design: Endovascular Acute Stroke Intervention–Tandem Occlusion (EASI-TOC) is a multicentre, prospective, randomised, open-label, blinded end-point (PROBE) controlled trial. Adult patients with a disabling acute anterior circulation stroke (intracranial carotid, M1 or M2 segment occlusion) and salvageable brain tissue who undergo EVT within 24 h of onset, are eligible for enrolment if they have an angiographically confirmed atherosclerotic carotid tandem lesion. Patients are randomised 1:1 to acute carotid stenting or no stenting during EVT. Study endpoints: The primary outcome is the proportion of patients achieving a favourable functional outcome (mRS 0–2) at 90 days. Secondary outcomes include 12-month mRS, recanalisation, the 90-day rate of recurrent ipsilateral stroke or retinal ischaemia, the proportion of patients with ICA thrombosis, 90-day Montreal Cognitive Assessment score and quality of life. Safety outcomes include any ICH, sICH, all-cause mortality and procedural complications. Summary: Endovascular Acute Stroke Intervention—Tandem Occlusion is a pragmatic trial addressing a critical gap in the acute management of patients with tandem carotid lesions by evaluating whether acute carotid stenting provides a functional benefit over no stenting in patients undergoing EVT. Trial registration: ClinicalTrials.gov NCT04261478.
KW - acute stroke therapy
KW - carotid stenting
KW - cerebral infarction
KW - clinical trial
KW - ischaemic stroke
KW - thrombectomy
UR - https://www.scopus.com/pages/publications/105036784775
U2 - 10.1093/esj/aakag036
DO - 10.1093/esj/aakag036
M3 - Artículo
C2 - 42024493
AN - SCOPUS:105036784775
SN - 2396-9873
VL - 11
JO - European Stroke Journal
JF - European Stroke Journal
IS - 4
ER -