Emergent carotid artery stenting in atherosclerotic disease of the internal carotid artery with tandem intracranial occlusion

Abstract

Background: Several randomized clinical trials have proven the safety and efficacy of mechanical thrombectomy (MT) in large vessel occlusions; nonetheless, there is still no consensus concerning hyperacute management of tandem occlusions. Recent studies have suggested that emergent carotid artery stenting (eCAS), along with mechanical thrombectomy, is an effective and safe treatment option.

Aims: To characterize the safety and short-term outcome of patients treated with eCAS during endovascular treatment of acute ischaemic stroke.

Methods: Review of the prospective patient registry submitted to MT for anterior circulation acute ischaemic stroke in a single referral centre and selection of patients treated with eCAS for atherosclerotic occlusion or near-occlusion of cervical internal carotid artery during 22 consecutive months. Clinical data was collected, and assessment of procedure safety and 3-month-outcome were performed.

Results: Among 156 patients submitted to MT, 16 patients (10.3%) underwent eCAS. Most patients were male (15/16), median age was 64.5 years (interquartile range [IQR] = 57-75), median admission NIHSS was 14 (IQR = 11.5-19) and 10/16 patients had been submitted to intravenous thrombolysis. Successful recanalization was obtained in 93.8% of the patients. One patient (6.3%) experienced symptomatic intracranial haemorrhage, one patient experienced early intra-stent thrombosis and one patient developed cerebral hyperperfusion syndrome. At 3-month follow-up, 11 patients were independent (68.8%) and 1 patient had died (6.3%).

Conclusions: In this study, positive results were obtained using eCAS. Although an optimal intervention for this type of occlusions has not yet been formally established, eCAS has been surging has a feasible and safe treatment option.

Keywords: Atherosclerotic disease; Carotid artery stenting; Thrombectomy.