CASES
(2026)Objective
PROBE non-inferiority trial comparing immediate carotid artery stenting (CAS) during EVT vs deferred carotid management in patients with tandem lesions (intracranial LVO + ipsilateral carotid stenosis/occlusion).
Study Summary
• Primary 90-day mRS full analysis: 1.06 (0.79-1.43); per-protocol 1.10 (0.81-1.50) — non-inferiority not claimed.
• 90d mRS 0-2: 53% vs 48% (NS).
• Final mTICI >=2b: 87% vs 83% (PP sig).
• Carotid reocclusion 24h: 19% vs 45% (sig); 90d: 19% vs 39% (sig).
• sICH 3.8% vs 3.0% (NS); 90d mortality 25% vs 23% (NS).
• 90d mRS 0-2: 53% vs 48% (NS).
• Final mTICI >=2b: 87% vs 83% (PP sig).
• Carotid reocclusion 24h: 19% vs 45% (sig); 90d: 19% vs 39% (sig).
• sICH 3.8% vs 3.0% (NS); 90d mortality 25% vs 23% (NS).
Intervention
Immediate CAS during EVT with IV ASA loading + DAPT >=3 months vs EVT + deferred carotid management
Inclusion Criteria
Belgium, Netherlands. Intracranial LVO (ICA/M1/M2) with ipsilateral carotid stenosis (>=50% NASCET) or occlusion of presumed atherosclerotic origin (other etiology excluded); EVT within 24 h w/wo IVT; NIHSS >=2.
Study Design
Arms: Immediate CAS during EVT vs EVT + deferred carotid management
Patients per Arm: Immediate CAS n=300 (incl. 34 crossovers) vs Deferred n=297 (incl. 9 crossovers); total 597
Outcome
• Primary 90-day mRS full analysis set: 1.06 (0.79-1.43); per-protocol: 1.10 (0.81-1.50). Non-inferiority not claimed.
• 90d mRS 0-2: 53% vs 48% (NS).
• Final mTICI >=2b: 87% vs 83% (PP sig).
• Carotid reocclusion 24h (CTA): 19% vs 45% (sig); 90d (US): 19% vs 39% (sig).
• sICH: 3.8% vs 3.0% (NS).
• 90d mortality: 25% vs 23% (NS).
• 90d mRS 0-2: 53% vs 48% (NS).
• Final mTICI >=2b: 87% vs 83% (PP sig).
• Carotid reocclusion 24h (CTA): 19% vs 45% (sig); 90d (US): 19% vs 39% (sig).
• sICH: 3.8% vs 3.0% (NS).
• 90d mortality: 25% vs 23% (NS).