ABSTRACT NUMBER: ESOC2026A1738 THE INFLUENCE OF CAROTID PLAQUE CALCIFICATION ON EVT OUTCOMES IN TANDEM LESION PATIENTS

Abstract Background and aims The optimal management for extracranial carotid artery stenosis of presumed atherosclerotic origin and intracranial LVO (‘tandem lesions’) during endovascular treatment (EVT) in patients with acute ischemic stroke is investigated in clinical trials. The carotid plaque composition could potentially influence clinical outcome in these patients. We aimed to assess the influence of carotid plaque calcification on outcomes after EVT in patients with atherosclerotic tandem lesions. Methods Patients with atherosclerotic tandem lesions who underwent EVT were selected from 3 EVT trials (MR CLEAN NO-IV, MED & LATE) recruiting patients between 2018 and 2022. Calcium scores were calculated with the Agatson method using CT angiography (CTA) scans at baseline. Primary endpoint was functional outcome measured with the modified Rankin Scale (mRS) at 90 days. Secondary endpoints were carotid restenosis (≥50%) at 24 hours, mortality and symptomatic intracranial hemorrhage (sICH). Analyses were done using multivariable linear & logistic regression analyses. Results A total of 172 patients were included; 47 received carotid stenting during EVT. There was no significant association between high calcium score and functional outcome (aOR 0.92 (0.49 – 1.73)), carotid restenosis (aOR 0.64 (0.18 – 2.17), mortality (aOR 0.77 (0.35 – 1.68)), or sICH (aOR 1.81 (0.65 – 5.36)). No interaction between carotid stenting and calcium score was found. Conclusions Carotid plaque calcification was not associated with functional outcome or any of the secondary outcomes among TL patients undergoing EVT. Ongoing clinical trials will answer whether carotid artery stenting during EVT is suitable for highly calcified carotid artery lesions in the setting of acute stroke. Conflict of interest T. van Elk: Nothing to disclose. R. Huizinga: Nothing to disclose. R. Lemmens: Nothing to disclose. F. Roder: Nothing to disclose. P.J. Nederkoorn: Nothing to disclose. R.J. van Oostenbrugge: Nothing to disclose. C.B. Majoie: Nothing to disclose. C.J. Zeebregts: Nothing to disclose. M. Uyttenboogaart: Nothing to disclose.