Carotid Artery Stenting for Stroke

(EASI-TOC Trial)

This trial aims to determine if adding a stent (a small tube) to open blocked arteries during a stroke procedure improves recovery compared to the procedure alone. It focuses on individuals experiencing a stroke due to blockages in both the brain's blood vessels and the neck's carotid artery. Participants should have a sudden, severe stroke affecting the brain's main arteries and a significant blockage in the neck's carotid artery. The trial compares patients receiving standard stroke care with a stent (carotid artery stenting) to those receiving standard care without a stent. As an unphased trial, this study allows participants to contribute to important research that could enhance stroke recovery treatments.

The trial protocol does not specify whether you need to stop taking your current medications. However, if you have a known contra-indication to antiplatelet therapy, you may not be eligible to participate.

A previous study showed that carotid artery stenting (CAS) is as safe as carotid endarterectomy, another common treatment for narrowing of the carotid arteries. Research indicates that the safety of CAS depends on the doctor's experience. With more practice, doctors tend to achieve better outcomes with CAS.

Real-world data suggests that CAS is generally well-tolerated in both symptomatic and asymptomatic patients. However, it's important to remember that, like any medical procedure, CAS can still carry risks. Some studies have found a higher risk of complications with less experienced doctors.

Carotid artery stenting for stroke is unique because it offers a way to re-open narrowed carotid arteries by placing a stent during the acute thrombectomy procedure. Unlike the standard of care that typically involves just thrombectomy and intravenous thrombolysis, this approach directly addresses cervical carotid artery stenosis at the same time. Researchers are excited because this could potentially reduce the risk of recurrent strokes by ensuring better blood flow immediately, rather than waiting for a separate procedure to address the stenosis.

In this trial, some participants will receive carotid artery stenting during the acute thrombectomy procedure, while others will not. Research has shown that using stents in the carotid artery can aid stroke recovery. Studies have found that patients receiving stents during procedures to open blocked blood vessels often recover better after 90 days, enabling them to perform daily activities with little or no assistance. The International Carotid Stenting Study found that stenting is as safe and effective as other common procedures, like carotid endarterectomy, within the first 30 days. Although high-quality trial data remains limited, these findings suggest that stenting could be a promising treatment for stroke patients with severe artery blockages.²⁵⁶⁷⁸