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Multicenter Study
. 2025 Sep;10(3):694-704.
doi: 10.1177/23969873251323488. Epub 2025 Feb 28.

Endovascular treatment for isolated cervical internal carotid artery occlusion: ETIICA study

João Pedro Marto  1   2 , Christoph Riegler  3   4 , Pimrapat Gebert  5   6 , Tilman Reiff  7 , Marek Sykora  8   9 , Marcin Wiącek  10 , David Pakizer  11 , André Araújo  12 , Adrien Ter Schiphorst  13 , João André Sousa  14 , Arno Reich  15 , Belen Flores Pina  16 , Lukas Mayer-Suess  17 , Cristina Hobeanu  18 , Marialuisa Zedde  19 , João Nuno Ramos  20 , Georgios Tsivgoulis  21 , Pedro Castro  22 , Sven Poli  23   24 , José Nuno Alves  25 , Anne Dusart  26 , Blanca Fuentes  27 , Herbert Tejada Meza  28   29 , Jelle Demeestere  30 , Susanne Wegener  31   32 , Lars Kellert  33 , Patricia Calleja  34 , Cristina Panea  35   36 , Christoph Vollmuth  37 , Liliana Pereira  38 , Ronen R Leker  39 , Timo Uphaus  40 , Andrea Zini  41 , Henrik Gensicke  42   43 , Gauthier Duloquin  44 , Taraneh Ebrahimi  45 , Alexander Salerno  46 , Cristina Tiu  47 , Thanh N Nguyen  48 , Sebastian García-Madrona  49 , Marta Bilik  50 , Shadi Yaghi  51 , Halina Sienkiewicz-Jarosz  52 , Michał Karliński  53 , Stefan Krebs  8 , Eva Hurtíková  54 , Nathalia Ferreira  14 , João Sargento-Freitas  14 , João Pinho  15 , Isabel Rodriguez Caamaño  16 , Elke Ruth Gizewski  55 , Pierre Seners  18   56 , Rosario Pascarella  57 , Klearchos Psychogios  58 , Alexandra Gomez Exposito  23   24 , Sara Gomes  25 , Flavio Bellante  26 , Jorge Rodríguez-Pardo  27 , Mario Bautista Lacambra  29   59 , Robin Lemmens  30 , Corinne Inauen  31 , Johannes Wischmann  33 , Fernando Ostos  34 , Vlad Tiu  35   36 , Karl Georg Haeusler  37 , Miguel Rodrigues  38 , Issa Metanis  39 , Marianne Hahn  40 , Maria Maddalena Viola  41 , Simon Truessel  42 , Yannick Bejot  44 , Louisa Nitsch  45 , Davide Strambo  46 , Elena Oana Terecoasa  47 , Mohamad Abdalkader  48 , Alicia de Felipe  49 , Farhan Khan  51 , Caroline Arquizan  13 , Manuel Ribeiro  12 , Martin Roubec  11   54 , Izabella Tomaszewska-Lampart  10 , Julia Ferrari  8 , Peter Ringleb  7 , Christian H Nolte  3   4   5   60
Affiliations
Multicenter Study

Endovascular treatment for isolated cervical internal carotid artery occlusion: ETIICA study

João Pedro Marto et al. Eur Stroke J. 2025 Sep.

Abstract

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.

Keywords: Endovascular treatment; cervical carotid; internal carotid artery; mechanical thrombectomy; occlusion; outcome.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Modified Rankin Scale at 3 months according to treatment groups.
Figure 2.
Figure 2.
Forest plot for interaction analysis.
See this image and copyright information in PMC

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