Emergent Carotid Stenting in Acute Ischemic Stroke

Study Overview
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Brief Summary
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The successful recanalization is the essential standard for the tandem lesions in acute anterior ischemic stroke. However, one of the common complications after emergent carotid stenting is hemorrhagic transformation that makes the effect of this method controversial. The investigators investigated whether emergent carotid stenting achieved the improvement of clinical outcome in acute large vessel occlusion stroke.

Detailed Description
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Tandem occlusions estimated from 10% to 30% in acute anterior circulation ischemic stroke. These acute lesions had a worse prognosis with mortality rate about 50%, if the aggresive medical treatment, even intravenous thrombolysis alone was the first choice. The HERMES meta-analysis involving in mechanical thrombectomy from individual data of 5 randomized controlled trials showed benefit of mechanical thrombectomy of 122 tandem occlusions compared with medical management alone, but the endovascular treatment methods are debatable between angioplasty versus stenting at proximal extracranial carotid occlusion after successful recanalization in the intracranial segments. Multiple studies recorded recently the emergent carotid stenting was the additional option to improve cerebral blood flow which associated to favorable outcomes after acute tandem occlusions. However, there was a lack of evidence for the benefit of emergent carotid stenting in tandem occlusions in Asia. Therefore, the investigators aimed in this study to access the favorable outcomes in case of tandem occlusions treated with this procedure.

Official Title
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Emergent Carotid Stenting in Acute Ischemic Stroke

Conditions
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Acute Stroke, Ischemic Stroke, Acute, Carotid Stenosis

Intervention / Treatment
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* Procedure: Emergent Carotid Stenting


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 18 years old Onset to treatment time < 24 hours NIHSS ≥ 6 Exclusion Criteria: Premorbid mRS > 2 Loss to follow up after discharge

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Emergent Carotid Stenting (ECS)<br>Emergent Carotid Stenting in acute ischemic stroke caused by tandem occlusions | Procedure: Emergent Carotid Stenting<br>* Emergent Carotid Stenting in acute ischemic stroke caused by tandem occlusions<br>* Other names: ECS;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The favorable 3-month outcome rate | The favorable 3-month outcome rate was accessed by modified Rankin Score (mRS), which comprised of included good (mRS 0 - ≤ 2) and fair (mRS 3). | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The symptomatic intracerebral hemorrhage rate | The symptomatic intracerebral hemorrhage was defined as patient's intracerebral hemorrhage with postprocedural mRS ≥ 5 and there were no other evident causes for the increased mRS. | 24 hours after emergent carotid stenting | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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internal carotid artery, acute ischemic stroke, stenting, tandem occlusions