{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T13:58:44Z","timestamp":1781186324239,"version":"3.54.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":103,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"BeNeFIT program","award":["BeNeFIT call 2021, CASES study - 21561"],"award-info":[{"award-number":["BeNeFIT call 2021, CASES study - 21561"]}]},{"name":"BeNeFIT program","award":["BeNeFIT call 2021, CASES study - 21561"],"award-info":[{"award-number":["BeNeFIT call 2021, CASES study - 21561"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The optimal acute management of patients with acute ischemic stroke and a tandem lesion, defined as intracranial large vessel occlusion (LVO) with concomitant carotid artery stenosis or occlusion, remains unclear. Our aim is to assess the efficacy and safety of immediate carotid artery stenting (CAS) compared to delayed management in patients undergoing endovascular treatment (EVT) for acute ischemic stroke due to tandem lesions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>CASES is a phase 3 multicenter prospective randomized open-label blinded endpoint (PROBE) non-inferiority clinical trial. Patients with a computed tomography angiography proven intracranial LVO in the anterior circulation and ipsilateral proximal carotid artery stenosis (\u2a7e50%) or occlusion of presumed atherosclerotic origin will be randomized to either immediate CAS during EVT or to EVT followed by a deferred strategy, which may include carotid endarterectomy (CEA), CAS, or medical management. CASES will be conducted in 27 EVT centers in Belgium and the Netherlands. A total of 600 patients will be included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study outcomes<\/jats:title>\n                    <jats:p>The primary outcome is the score on the modified Rankin Scale (mRS) at 90\u2009days. Secondary outcomes include excellent (mRS 0\u20131) and good (mRS 0\u20132) functional outcome at 90\u2009days, stroke severity measured with the National Institutes of Health Stroke Scale (NIHSS) at 24\u2009h and 5\u20137\u2009days, recanalization, infarct volume at 24\u2009h, ischemic stroke recurrence, carotid artery re-occlusion, symptomatic intracranial hemorrhage, and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>This study will provide high-quality randomized data on the efficacy and safety of immediate CAS in patients undergoing EVT for acute ischemic stroke due to a tandem lesion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT06511089; ISRCTN 14956654<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23969873251319941","type":"journal-article","created":{"date-parts":[[2025,2,17]],"date-time":"2025-02-17T00:09:18Z","timestamp":1739750958000},"page":"995-1002","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Carotid Artery Stenting during Endovascular treatment of acute ischemic Stroke (CASES) study protocol for a multicenter randomized clinical trial"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4240-7645","authenticated-orcid":false,"given":"Louise","family":"Maes","sequence":"first","affiliation":[{"name":"Department of Neurology, University Hospitals Leuven, Leuven, Belgium 1"},{"name":"Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodora","family":"Van Elk","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"van der Meij","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center Amsterdam, Location AMC, Amsterdam, The Netherlands 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Femke","family":"Roelofs","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center Amsterdam, Location AMC, Amsterdam, The Netherlands 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kris","family":"Bogaerts","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary Care, KU Leuven, I-BioStat, Leuven, Belgium and UHasselt, I-BioStat, Diepenbeek, Belgium 5"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinoud PH","family":"Bokkers","sequence":"additional","affiliation":[{"name":"Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 6"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert J","family":"de Borst","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands 7"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heleen M","family":"den Hertog","sequence":"additional","affiliation":[{"name":"Department of Neurology, Isala, Zwolle, The Netherlands 8"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diederik WJ","family":"Dippel","sequence":"additional","affiliation":[{"name":"Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands 9"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Fran\u00e7ois","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium 10"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"No\u00e9mie","family":"Ligot","sequence":"additional","affiliation":[{"name":"Department of Neurology, CUB H\u00f4pital Erasme, Universit\u00e9 libre de Bruxelles (ULB), Brussels, Belgium 11"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hester F","family":"Lingsma","sequence":"additional","affiliation":[{"name":"Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands 12"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles BLM","family":"Majoie","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands 13"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo PP","family":"Peluso","sequence":"additional","affiliation":[{"name":"Division of Neuroradiology, Department of Radiology, University Hospitals Leuven, Leuven, Belgium 14"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Illario","family":"Tancredi","sequence":"additional","affiliation":[{"name":"Department of Neurology, H\u00f4pital Civil Marie Curie, Charleroi, Belgium, Belgium 15"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ido R","family":"van den Wijngaard","sequence":"additional","affiliation":[{"name":"Department of Neurology, Leiden University Medical Center (LUMC), Leiden, The Netherlands 16"},{"name":"Department of Neurology, Haaglanden Medical Center (HMC), The Hague, The Netherlands 17"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aad","family":"van der Lugt","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands 18"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5503-5724","authenticated-orcid":false,"given":"Laetitia","family":"Yperzeele","sequence":"additional","affiliation":[{"name":"Antwerp NeuroVascular Center and Stroke Unit, Department of Neurology, University Hospital Antwerp, Edegem, Belgium 19"},{"name":"Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium 20"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clark J","family":"Zeebregts","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands 21"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J","family":"Nederkoorn","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center Amsterdam, Location AMC, Amsterdam, The Netherlands 4"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Lemmens","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospitals Leuven, Leuven, Belgium 1"},{"name":"Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Leuven, Belgium 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6934-4456","authenticated-orcid":false,"given":"Maarten","family":"Uyttenboogaart","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 3"},{"name":"Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 6"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,1]]},"reference":[{"key":"2026012115063931300_bibr1-23969873251319941","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1161\/STROKEAHA.118.021893","article-title":"Emergent management of tandem lesions in acute ischemic stroke","volume":"50","author":"Jadhav","year":"2019","journal-title":"Stroke"},{"key":"2026012115063931300_bibr2-23969873251319941","doi-asserted-by":"crossref","first-page":"3145","DOI":"10.1161\/STROKEAHA.117.018264","article-title":"Thrombectomy in acute stroke with tandem occlusions from dissection versus atherosclerotic cause","volume":"48","author":"Gory","year":"2017","journal-title":"Stroke"},{"key":"2026012115063931300_bibr3-23969873251319941","doi-asserted-by":"crossref","first-page":"2301","DOI":"10.1161\/01.STR.0000237070.80133.1d","article-title":"Tandem internal carotid artery\/middle cerebral artery occlusion: an independent predictor of poor outcome after systemic thrombolysis","volume":"37","author":"Rubiera","year":"2006","journal-title":"Stroke"},{"key":"2026012115063931300_bibr4-23969873251319941","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1016\/S0140-6736(16)00163-X","article-title":"Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials","volume":"387","author":"Goyal","year":"2016","journal-title":"Lancet"},{"key":"2026012115063931300_bibr5-23969873251319941","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.ejvsvf.2023.12.002","article-title":"Immediate carotid artery stenting or deferred treatment in patients with tandem carotid lesions treated endovascularly for acute ischaemic stroke","volume":"61","author":"van Elk","year":"2024","journal-title":"EJVES Vasc Forum"},{"key":"2026012115063931300_bibr6-23969873251319941","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1056\/NEJM199108153250701","article-title":"Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis","volume":"325","author":"Barnett","year":"1991","journal-title":"N Engl J Med"},{"key":"2026012115063931300_bibr7-23969873251319941","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1016\/0140-6736(91)92916-P","article-title":"MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. European Carotid Surgery Trialists' Collaborative Group","volume":"337","author":"Warlow","year":"1991","journal-title":"Lancet"},{"key":"2026012115063931300_bibr8-23969873251319941","doi-asserted-by":"crossref","first-page":"3097","DOI":"10.1161\/STROKEAHA.120.033032","article-title":"Endovascular therapy of anterior circulation tandem occlusions","volume":"52","author":"Anadani","year":"2021","journal-title":"Stroke"},{"key":"2026012115063931300_bibr9-23969873251319941","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1161\/STROKEAHA.120.031797","article-title":"Tandem lesions in anterior circulation stroke: analysis of the German Stroke Registry-endovascular treatment","volume":"52","author":"Feil","year":"2021","journal-title":"Stroke"},{"key":"2026012115063931300_bibr10-23969873251319941","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.21037\/atm-2020-cass-17","article-title":"Treatment of the extracranial carotid artery in tandem lesions during endovascular treatment of acute ischemic stroke: a systematic review and meta-analysis","volume":"8","author":"Hellegering","year":"2020","journal-title":"Ann Transl Med"},{"key":"2026012115063931300_bibr11-23969873251319941","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1136\/neurintsurg-2020-015817","article-title":"Acute carotid stenting in patients undergoing thrombectomy: a systematic review and meta-analysis","volume":"13","author":"Dufort","year":"2021","journal-title":"J Neurointerv Surg"},{"key":"2026012115063931300_bibr12-23969873251319941","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.121.022335","article-title":"Acute carotid artery stenting versus balloon angioplasty for tandem occlusions: a systematic review and meta-analysis","volume":"11","author":"Zevallos","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2026012115063931300_bibr13-23969873251319941","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.22.6.711","article-title":"Methods, patient characteristics, and progress","volume":"22","author":"North American Symptomatic Carotid Endarterectomy Trial (NASCET) Steering Committee. North American Symptomatic Carotid Endarterectomy Trial","year":"1991","journal-title":"Stroke"},{"key":"2026012115063931300_bibr14-23969873251319941","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1016\/S0140-6736(00)02237-6","article-title":"Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score","volume":"355","author":"Barber","year":"2000","journal-title":"Lancet"},{"key":"2026012115063931300_bibr15-23969873251319941","doi-asserted-by":"crossref","first-page":"2274","DOI":"10.3174\/ajnr.A6888","article-title":"Considerations for antiplatelet management of carotid stenting in the setting of mechanical thrombectomy: a Delphi consensus statement","volume":"41","author":"Goyal","year":"2020","journal-title":"AJNR Am J Neuroradiol"},{"key":"2026012115063931300_bibr16-23969873251319941","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1161\/01.STR.19.5.604","article-title":"Interobserver agreement for the assessment of handicap in stroke patients","volume":"19","author":"van Swieten","year":"1988","journal-title":"Stroke"},{"key":"2026012115063931300_bibr17-23969873251319941","doi-asserted-by":"crossref","first-page":"2981","DOI":"10.1161\/STROKEAHA.115.010049","article-title":"The Heidelberg Bleeding Classification: classification of bleeding events after ischemic stroke and reperfusion therapy","volume":"46","author":"von Kummer","year":"2015","journal-title":"Stroke"},{"key":"2026012115063931300_bibr18-23969873251319941","article-title":"Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry)","volume":"360","author":"Jansen","year":"2018","journal-title":"BMJ"},{"key":"2026012115063931300_bibr19-23969873251319941","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1259\/0007-1285-44-526-793","article-title":"Repeated assessment of results in clinical trials of cancer treatment","volume":"44","author":"Haybittle","year":"1971","journal-title":"Br J Radiol"},{"key":"2026012115063931300_bibr20-23969873251319941","doi-asserted-by":"crossref","first-page":"2594","DOI":"10.1001\/jama.2012.87802","article-title":"Reporting of noninferiority and equivalence randomized trials: extension of the CONSORT 2010 statement","volume":"308","author":"Piaggio","year":"2012","journal-title":"JAMA"},{"key":"2026012115063931300_bibr21-23969873251319941","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.neurad.2019.08.003","article-title":"A randomized pilot study of patients with tandem carotid lesions undergoing thrombectomy","volume":"47","author":"Poppe","year":"2020","journal-title":"J Neuroradiol"},{"key":"2026012115063931300_bibr22-23969873251319941","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1177\/1747493020929948","article-title":"Effect of emergent carotid stenting during endovascular therapy for acute anterior circulation stroke patients with tandem occlusion: a multicenter, randomized, clinical trial (TITAN) protocol","volume":"16","author":"Zhu","year":"2021","journal-title":"Int J Stroke"},{"key":"2026012115063931300_bibr23-23969873251319941","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/S1474-4422(20)30276-3","article-title":"Informed consent procedures for emergency interventional research in patients with traumatic brain injury and ischaemic stroke","volume":"19","author":"Kompanje","year":"2020","journal-title":"Lancet Neurol"},{"key":"2026012115063931300_bibr24-23969873251319941","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1001\/jama.2016.13647","article-title":"Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis","volume":"316","author":"Saver","year":"2016","journal-title":"JAMA"},{"key":"2026012115063931300_bibr25-23969873251319941","doi-asserted-by":"crossref","first-page":"104447","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104447","article-title":"Neurological deficits in stroke patients that may impede the capacity to provide informed consent for endovascular treatment trials","volume":"28","author":"Janssen","year":"2019","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"2026012115063931300_bibr26-23969873251319941","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1177\/23969873211057421","article-title":"Patient and proxies' attitudes towards deferred consent in randomised trials of acute treatment for stroke: a qualitative survey","volume":"6","author":"van den Bos","year":"2021","journal-title":"Eur Stroke J"}],"container-title":["European Stroke Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23969873251319941","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23969873251319941","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/10\/3\/995\/65866345\/23969873251319941.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/10\/3\/995\/65866345\/23969873251319941.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T20:07:59Z","timestamp":1769026079000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/esj\/article\/10\/3\/995\/8376582"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,1]]},"references-count":26,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,9,1]]}},"URL":"https:\/\/doi.org\/10.1177\/23969873251319941","relation":{},"ISSN":["2396-9873","2396-9881"],"issn-type":[{"value":"2396-9873","type":"print"},{"value":"2396-9881","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,9,1]]},"published":{"date-parts":[[2025,9,1]]}}}