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

Santiago Ortega-Gutierrez; Aaron Rodriguez-Calienes; Deep Pujara; Clark Sitton; Milagros Galecio-Castillo; Ameer E. Hassan; Michael G. Abraham; Michael Chen; Spiros Blackburn; Scott E. Kasner; Heena Olalde; Malik Ghannam; Muhammad S. Hussain; Enrique C. Leira; Mario Martínez-Galdámez; Amir Shaban; Jenny P. Tsai; Hannah Roeder; Julie C. Gudenkauf; Ronald Budzik; Nirav Vora; Ricardo A. Hanel; Amin Aghaebrahim; Frances Colgan; Maria Angeles de Miquel; Chirag D. Gandhi; Fawaz Al-Mufti; Jordi Blasco; Luis San Román Manzanera; Nabeel A. Herial; Nathan W. Manning; Andrew Cheung; Osman Kozak; Bernard Yan; Peter J. Mitchell; Koji Ebersole; Gabor Toth; Michael Gooch; Daniel Gibson; Daniel H. Sahlein; Krishna Amuluru; Mohammad Ammar Abdulrazzak; Kelsey Duncan; Dana Defta; Faris Shaker; Faisal Al-Shaibi; Abhishek Ray; Jeffrey Sunshine; Yin C. Hu; Jan Karl Burkhardt; Osman Mir; Bader Alenzi; Tareq Kass-Hout; Rishi Gupta; Stavropoula I. Tjoumakaris; Pascal M. Jabbour; Thanh N. Nguyen; Johanna Therese Fifi; Vitor Mendes Pereira; Nicholas Bambakidis; Michael D. Hill; James C. Grotta; Marc Ribo; Bruce C.V. Campbell; Edgar A. Samaniego; Amrou Sarraj

doi:10.1212/WNL.0000000000210269

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

Santiago Ortega-Gutierrez
, Aaron Rodriguez-Calienes
, Deep Pujara
, Clark Sitton
, Milagros Galecio-Castillo
, Ameer E. Hassan
, Michael G. Abraham
, Michael Chen
, Spiros Blackburn
, Scott E. Kasner
, Heena Olalde
, Malik Ghannam
, Muhammad S. Hussain
, Enrique C. Leira
, Mario Martínez-Galdámez
, Amir Shaban
, Jenny P. Tsai
, Hannah Roeder
, Julie C. Gudenkauf
, Ronald Budzik

Nirav Vora, Ricardo A. Hanel, Amin Aghaebrahim, Frances Colgan, Maria Angeles de Miquel, Chirag D. Gandhi, Fawaz Al-Mufti, Jordi Blasco, Luis San Román Manzanera, Nabeel A. Herial, Nathan W. Manning, Andrew Cheung, Osman Kozak, Bernard Yan, Peter J. Mitchell, Koji Ebersole, Gabor Toth, Michael Gooch, Daniel Gibson, Daniel H. Sahlein, Krishna Amuluru, Mohammad Ammar Abdulrazzak, Kelsey Duncan, Dana Defta, Faris Shaker, Faisal Al-Shaibi, Abhishek Ray, Jeffrey Sunshine, Yin C. Hu, Jan Karl Burkhardt, Osman Mir, Bader Alenzi, Tareq Kass-Hout, Rishi Gupta, Stavropoula I. Tjoumakaris, Pascal M. Jabbour, Thanh N. Nguyen, Johanna Therese Fifi, Vitor Mendes Pereira, Nicholas Bambakidis, Michael D. Hill, James C. Grotta, Marc Ribo, Bruce C.V. Campbell, Edgar A. Samaniego, Amrou Sarraj^*

^*Corresponding author for this work

Department of Neurosurgery and Radiology
University of Iowa
Universidad Científica del Sur
Case Western Reserve University
University of Texas Health Science Center at Houston
Valley Baptist Medical Center
University of Kansas
Rush University Medical Center
University of Pennsylvania
Cleveland Clinic Foundation
Hospital Clínico Universitario de Valladolid
Riverside Methodist Hospital
Baptist Health
Canterbury District Health Board
Hospital Universitari Bellvitge (L'Hospitalet de Llobregat)
Westchester Medical Center
Servicio de Nefrología, Hospital Clínic
Thomas Jefferson University
Liverpool Hospital
Abington Jefferson Health
Department of Neurology
Royal Melbourne Hospital
Goodman Campbell Brain and Spine
Department of Neurosurgery
Texas Stroke Institute
King Fahad Specialist Hospital, Dammam
The University of Chicago
WellStar Health
Boston Medical Center
Icahn School of Medicine at Mount Sinai
University of Toronto
University of Calgary
Memorial Hermann Healthcare System
Vall d'Hebron Hospital Universitari

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

4 Scopus citations

Abstract

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.

Original language	English
Article number	e210269
Journal	Neurology
Volume	104
Issue number	4
DOIs	https://doi.org/10.1212/WNL.0000000000210269
State	Published - 27 Jan 2025
Externally published	Yes

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Ortega-Gutierrez, S., Rodriguez-Calienes, A., Pujara, D., Sitton, C., Galecio-Castillo, M., Hassan, A. E., Abraham, M. G., Chen, M., Blackburn, S., Kasner, S. E., Olalde, H., Ghannam, M., Hussain, M. S., Leira, E. C., Martínez-Galdámez, M., Shaban, A., Tsai, J. P., Roeder, H., Gudenkauf, J. C., ... Sarraj, A. (2025). Endovascular Thrombectomy for Extracranial Internal Carotid Artery Occlusions With Large Ischemic Strokes. Neurology, 104(4), Article e210269. https://doi.org/10.1212/WNL.0000000000210269

@article{f31c441776084257a863894926918663,

title = "Endovascular Thrombectomy for Extracranial Internal Carotid Artery Occlusions With Large Ischemic Strokes",

abstract = "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.",

author = "Santiago Ortega-Gutierrez and Aaron Rodriguez-Calienes and Deep Pujara and Clark Sitton and Milagros Galecio-Castillo and Hassan, \{Ameer E.\} and Abraham, \{Michael G.\} and Michael Chen and Spiros Blackburn and Kasner, \{Scott E.\} and Heena Olalde and Malik Ghannam and Hussain, \{Muhammad S.\} and Leira, \{Enrique C.\} and Mario Mart{\'i}nez-Gald{\'a}mez and Amir Shaban and Tsai, \{Jenny P.\} and Hannah Roeder and Gudenkauf, \{Julie C.\} and Ronald Budzik and Nirav Vora and Hanel, \{Ricardo A.\} and Amin Aghaebrahim and Frances Colgan and \{de Miquel\}, \{Maria Angeles\} and Gandhi, \{Chirag D.\} and Fawaz Al-Mufti and Jordi Blasco and \{Rom{\'a}n Manzanera\}, \{Luis San\} and Herial, \{Nabeel A.\} and Manning, \{Nathan W.\} and Andrew Cheung and Osman Kozak and Bernard Yan and Mitchell, \{Peter J.\} and Koji Ebersole and Gabor Toth and Michael Gooch and Daniel Gibson and Sahlein, \{Daniel H.\} and Krishna Amuluru and Abdulrazzak, \{Mohammad Ammar\} and Kelsey Duncan and Dana Defta and Faris Shaker and Faisal Al-Shaibi and Abhishek Ray and Jeffrey Sunshine and Hu, \{Yin C.\} and Burkhardt, \{Jan Karl\} and Osman Mir and Bader Alenzi and Tareq Kass-Hout and Rishi Gupta and Tjoumakaris, \{Stavropoula I.\} and Jabbour, \{Pascal M.\} and Nguyen, \{Thanh N.\} and Fifi, \{Johanna Therese\} and Pereira, \{Vitor Mendes\} and Nicholas Bambakidis and Hill, \{Michael D.\} and Grotta, \{James C.\} and Marc Ribo and Campbell, \{Bruce C.V.\} and Samaniego, \{Edgar A.\} and Amrou Sarraj",

note = "Publisher Copyright: Copyright {\textcopyright} 2025 American Academy of Neurology.",

year = "2025",

month = jan,

day = "27",

doi = "10.1212/WNL.0000000000210269",

language = "Ingl{\'e}s",

volume = "104",

journal = "Neurology",

issn = "0028-3878",

publisher = "Lippincott Williams and Wilkins",

number = "4",

}

Ortega-Gutierrez, S, Rodriguez-Calienes, A, Pujara, D, Sitton, C, Galecio-Castillo, M, Hassan, AE, Abraham, MG, Chen, M, Blackburn, S, Kasner, SE, Olalde, H, Ghannam, M, Hussain, MS, Leira, EC, Martínez-Galdámez, M, Shaban, A, Tsai, JP, Roeder, H, Gudenkauf, JC, Budzik, R, Vora, N, Hanel, RA, Aghaebrahim, A, Colgan, F, de Miquel, MA, Gandhi, CD, Al-Mufti, F, Blasco, J, Román Manzanera, LS, Herial, NA, Manning, NW, Cheung, A, Kozak, O, Yan, B, Mitchell, PJ, Ebersole, K, Toth, G, Gooch, M, Gibson, D, Sahlein, DH, Amuluru, K, Abdulrazzak, MA, Duncan, K, Defta, D, Shaker, F, Al-Shaibi, F, Ray, A, Sunshine, J, Hu, YC, Burkhardt, JK, Mir, O, Alenzi, B, Kass-Hout, T, Gupta, R, Tjoumakaris, SI, Jabbour, PM, Nguyen, TN, Fifi, JT, Pereira, VM, Bambakidis, N, Hill, MD, Grotta, JC, Ribo, M, Campbell, BCV, Samaniego, EA & Sarraj, A 2025, 'Endovascular Thrombectomy for Extracranial Internal Carotid Artery Occlusions With Large Ischemic Strokes', Neurology, vol. 104, no. 4, e210269. https://doi.org/10.1212/WNL.0000000000210269

TY - JOUR

T1 - Endovascular Thrombectomy for Extracranial Internal Carotid Artery Occlusions With Large Ischemic Strokes

AU - Ortega-Gutierrez, Santiago

AU - Rodriguez-Calienes, Aaron

AU - Pujara, Deep

AU - Sitton, Clark

AU - Galecio-Castillo, Milagros

AU - Hassan, Ameer E.

AU - Abraham, Michael G.

AU - Chen, Michael

AU - Blackburn, Spiros

AU - Kasner, Scott E.

AU - Olalde, Heena

AU - Ghannam, Malik

AU - Hussain, Muhammad S.

AU - Leira, Enrique C.

AU - Martínez-Galdámez, Mario

AU - Shaban, Amir

AU - Tsai, Jenny P.

AU - Roeder, Hannah

AU - Gudenkauf, Julie C.

AU - Budzik, Ronald

AU - Vora, Nirav

AU - Hanel, Ricardo A.

AU - Aghaebrahim, Amin

AU - Colgan, Frances

AU - de Miquel, Maria Angeles

AU - Gandhi, Chirag D.

AU - Al-Mufti, Fawaz

AU - Blasco, Jordi

AU - Román Manzanera, Luis San

AU - Herial, Nabeel A.

AU - Manning, Nathan W.

AU - Cheung, Andrew

AU - Kozak, Osman

AU - Yan, Bernard

AU - Mitchell, Peter J.

AU - Ebersole, Koji

AU - Toth, Gabor

AU - Gooch, Michael

AU - Gibson, Daniel

AU - Sahlein, Daniel H.

AU - Amuluru, Krishna

AU - Abdulrazzak, Mohammad Ammar

AU - Duncan, Kelsey

AU - Defta, Dana

AU - Shaker, Faris

AU - Al-Shaibi, Faisal

AU - Ray, Abhishek

AU - Sunshine, Jeffrey

AU - Hu, Yin C.

AU - Burkhardt, Jan Karl

AU - Mir, Osman

AU - Alenzi, Bader

AU - Kass-Hout, Tareq

AU - Gupta, Rishi

AU - Tjoumakaris, Stavropoula I.

AU - Jabbour, Pascal M.

AU - Nguyen, Thanh N.

AU - Fifi, Johanna Therese

AU - Pereira, Vitor Mendes

AU - Bambakidis, Nicholas

AU - Hill, Michael D.

AU - Grotta, James C.

AU - Ribo, Marc

AU - Campbell, Bruce C.V.

AU - Samaniego, Edgar A.

AU - Sarraj, Amrou

PY - 2025/1/27

Y1 - 2025/1/27

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85217153389

U2 - 10.1212/WNL.0000000000210269

DO - 10.1212/WNL.0000000000210269

M3 - Artículo

C2 - 39869840

AN - SCOPUS:85217153389

SN - 0028-3878

VL - 104

JO - Neurology

JF - Neurology

IS - 4

M1 - e210269

ER -

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

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