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The following is a summary of “Endovascular Thrombectomy for Extracranial Internal Carotid Artery Occlusions With Large Ischemic Strokes,” published in the January 2025 issue of Neurology by Ortega-Gutierrez et al. 

Previous trials have established the efficacy and safety of endovascular thrombectomy (EVT) for large ischemic strokes. However, most excluded patients with extracranial internal carotid artery (e-ICA) occlusion. 

Researchers conducted a retrospective study to compare outcomes in patients with e-ICA occlusion and large ischemic strokes treated with EVT vs medical management (MM) 

They conducted a secondary analysis of the SELECT2 trial, a randomized controlled trial at 31 international sites. Adult patients with proximal intracranial anterior circulation large ischemic strokes (ASPECTS 3–5 or ischemic core ≥50 mL) and concomitant e-ICA occlusion were included. Primary outcomes were the distribution of modified Rankin Scale (mRS) scores at 90 days and symptomatic intracranial hemorrhage (sICH). 

The results showed that 62 (17.6%) of 352 enrolled patients had e-ICA occlusions, with 37 receiving EVT (median age 65 years; 38.5% women) and 25 receiving MM (median age 66 years; 28% women). ASPECTS (EVT: 5 vs MM: 5) and ischemic core volume (EVT: 100 mL vs MM: 103 mL) were similar between groups. The EVT successful reperfusion rate was 64.9%. Patients with EVT had significantly better functional outcomes (adjusted generalized odds ratio (OR) 2.51; 95% CI 1.43–4.39; P = 0.001), a higher proportion achieving independent ambulation at 90 days (EVT: 37.8% vs MM: 8%; adjusted relative ratio (aRR) 4.58; 95% CI 1.18–17.79; P = 0.037), and a higher proportion achieving functional independence (EVT: 21.6% vs MM: 8%; aRR 2.16; 95% CI 0.53–8.83; P = 0.285). There were no sICH or parenchymal hemorrhage type 2 events, and mortality was similar (aRR 0.75; 95% CI 0.39–1.45; P = 0.388). 

Investigators found that EVT led to better functional outcomes in patients with e-ICA occlusions and large ischemic strokes without significant safety concerns compared to MM. The optimal treatment for extracranial carotid occlusion remains uncertain. 

Source: neurology.org/doi/10.1212/WNL.0000000000210269