Endovascular treatment for isolated cervical internal carotid artery occlusion: ETIICA study
Authors: Marto João Pedro , Riegler Christoph , Gebert Pimrapat , Reiff Tilman , Sykora Marek , Wiącek Marcin , Pakizer David , Araújo André , ter Schiphorst Adrien , Sousa João André , Reich Arno , Pina Belen Flores , Mayer-Suess Lukas , Hobeanu Cristina , Zedde Marialuisa , Ramos João Nuno , Tsivgoulis Georgios , Castro Pedro , Poli Sven , Alves José Nuno , Dusart Anne , Fuentes Blanca , Tejada Meza Herbert , Demeestere Jelle , Wegener Susanne , Kellert Lars , Calleja Patricia , Panea Cristina , Vollmuth Christoph , Pereira Liliana , Leker Ronen R , Uphaus Timo , Zini Andrea , Gensicke Henrik , Duloquin Gauthier , Ebrahimi Taraneh , Salerno Alexander , Tiu Cristina , Nguyen Thanh N. , García-Madrona Sebastian , Bilik Marta , Yaghi Shadi , Sienkiewicz-Jarosz Halina , Karliński Michał , Krebs Stefan , Hurtíková Eva , Ferreira Nathalia , Sargento-Freitas João , Pinho João , Caamaño Isabel Rodriguez , Gizewski Elke Ruth , Seners Pierre , Pascarella Rosario , Psychogios Klearchos , Gomez Exposito Alexandra , Gomes Sara , Bellante Flavio , Rodríguez-Pardo Jorge , Bautista Lacambra Mario , Lemmens Robin , Inauen Corinne , Wischmann Johannes , Ostos Fernando , Tiu Vlad , Haeusler Karl Georg , Rodrigues Miguel , Metanis Issa , Hahn Marianne , Viola Maria Maddalena , Truessel Simon , Bejot Yannick , Nitsch Louisa , Strambo Davide , Terecoasa Elena Oana , Abdalkader Mohamad , de Felipe Alicia , Khan Farhan , Arquizan Caroline , Ribeiro Manuel , Roubec Martin , Tomaszewska-Lampart Izabella , Ferrari Julia , Ringleb Peter , Nolte Christian H. 
Published: February 2025

Introduction: Evidence regarding the benefit of endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to isolated cervical internal carotid artery occlusion (c-ICA-O) is lacking. We assessed the outcomes and safety of EVT in patients with isolated c-ICA-O. Methods: Retrospective multicenter cohort study of patients with an AIS due to isolated c-ICA-O, within 24-h since last-seen-well. Comparisons were made between EVT and best medical therapy (BMT). The primary outcome was 3-months modified Rankin Scale (mRS) ordinal shift. Secondary outcomes included 3-month favorable outcome (mRS 0–2, or return to pre-stroke mRS), symptomatic intracranial hemorrhage (sICH) and any parenchymal hemorrhage. Outcomes were compared combining inverse probability of treatment weighting with regression models and propensity score matching (PSM) as sensitivity analysis. Results: We analyzed 998 patients (66.2% male, mean age 71.1 ± 13.2 years). 487 (48.8%) patients received EVT and 511 (51.2%) received BMT. Patients receiving EVT had a higher admission NIHSS [13 (7–18) vs 5 (2–13)] compared to BMT. There was no difference between EVT and BMT groups in 3-month mRS shift (adjusted common odds ratio [OR], 1.01 [95% CI 0.76–1.34]) and favorable outcome (adjusted OR [aOR] 1.16 [95% CI 0.84–1.60]). No patient (0%) in the BMT group had sICH versus 1.6% in the EVT group. Parenchymal hemorrhage was numerically higher in EVT patients (2.7% vs 0.6%; aOR 3.85 [95% CI 0.98–15.23]). PSM analysis revealed similar results. Discussion and conclusion: In patients with isolated c-ICA-O, EVT was associated with similar odds of disability and intracranial bleeding compared to BMT. Randomized-controlled clinical trials in patients with isolated c-ICA-O are warranted.