Treating Intracranial Anterior Large Vessel Stroke Patients with Extracranial Carotid Disease

For stroke caused by an anterior-circulation large vessel occlusion, the benefits of endovascular treatment are robust and well-documented. But when there is also narrowing or occlusion of the extracranial carotid artery, the procedure is more complex because the affected extracranial area must be traversed to access the intracranial clot, which could increase the risk of vessel injury or embolization. In addition, placement of a permanent stent in the extracranial carotid is sometimes needed, which necessitates the use of dual-antiplatelet therapy and could increase hemorrhage risk. For these reasons, patients with apparent extracranial carotid occlusion or stenosis on computed tomographic angiography were excluded from some recent endovas…