# Thrombectomy with and without emergent stenting in acute ischemic stroke due to carotid artery dissection

## TL;DR

This study compares outcomes of stroke patients who received thrombectomy with or without stenting, finding that stenting improved recanalization and reduced mortality but did not improve functional recovery.

## Contribution

The study provides new evidence on the role of emergent stenting in carotid artery dissection-related stroke during thrombectomy.

## Key findings

- Emergent stenting increased successful recanalization rates.
- Stenting reduced 3-month mortality but did not improve functional independence.
- Risk of symptomatic intracerebral hemorrhage was similar between groups.

## Abstract

Whether thrombectomy with or without emergent carotid stenting improves outcomes in patients with large vessel occlusion (LVO) stroke due to carotid artery dissection (CAD) is unknown.

International multicentre observational study. Patients with LVO due to CAD undergoing thrombectomy with emergent stenting were compared to those without emergent stenting. The primary outcome was functional independence (modified Rankin Scale 0-2) at 3 months, secondary outcomes included early neurological improvement (ENI) within 24-48 h, successful recanalisation, symptomatic intracerebral haemorrhage (sICH) and mortality at 3 months. Inverse probability of treatment weighting and multivariable Poisson regression were used to adjust for group imbalances and to estimate the effect size, respectively.

Of 516 patients (mean age 53.8 years, 76% male) undergoing thrombectomy, 167 (32.4%) and 349 (67.6%) were treated with or without emergent carotid stenting, respectively. After robust adjustment, emergent stenting was not associated with functional independence (adjusted risk ratio [aRR] = 1.01; 95% confidence interval [CI], 0.89-1.15) or ENI (aRR = 1.07; 95% CI, 0.95-1.21) but with successful recanalisation (aRR = 1.29; 95% CI, 1.10-1.50) and reduced mortality at 3 months (aRR = 0.39; 95% CI, 0.15-0.99). Risk of sICH was equivalent (aRR = 1.01; 95% CI, 0.95-1.06).

In patients with LVO secondary to CAD, emergent stenting during endovascular procedure appeared safe, increased odds of successful recanalisation and reduced 3-month mortality rates. However, intraprocedural stenting was not associated with better functional outcome.