Background and Purpose Emergent carotid artery stenting (CAS) is technically challenging and has concerns for clinical outcome and complications. Moreover, there is no definite guidelines for endovascular treatment of tandem lesion in acute ischemic stroke.

Materials and methods Multicenter retrospective study including three hospitals was performed. Forty-five patients with acute ischemic stroke by atherosclerosis of the extracranial carotid artery were enrolled. Mean age was 73.8 (59–98) and male to female ratio was 38:7. Mean initial NIHSS was 12.8 (4–28). Intravenous t-PA was used in 20 (44.4%) patients. Mean initial stenosis of the ICA was 99.3%. Favorable neurological outcome was defined as modified Rankin Scale (mRS) ≤2 within 6 months clinical follow-up.

Results Enrolled patients were categorized into two groups: emergent CAS (n=27) or medical treatment (n=18). Reasons for medical treatment were as follows: spontaneous neurological improvement (n=4), technical failure of emergent CAS (n=7) and good collateral circulation (n=7). Good angiographic outcome (mTICI 3 or 2b) was achieved in 25 (92.6%) patients of the emCAS group. Reocclusion (n=3) and hyperperfusion syndrome (n=3, massive intracerebral hemorrhage, cerebral edema and status epilepticus) were identified after emergent CAS. Hemorrhagic transformation was developed in 11 (40.7%) patients of the emergent CAS group and 3 (16.7%) patients of the medical treatment group (p=0.11). The emergent CAS group showed a favorable neurological outcome (51.9% vs 22.2%, p=0.07) and a low rate of recurrent ischemic stroke (p=0.01) compared to the medical treatment group. In multi-variate analysis, no early neurological deterioration before procedure (p=0.04), use of IV t-PA (p=0.03),no intracranial tandem lesion (p=0.02) and emergent CAS (p=0.01) were related with a favorable neurological outcome.

Conclusions Emergent CAS for acute ischemic stroke is technically feasible and may give a chance to achieve good neurological outcome. However, physicians should pay attention to the risk of in-stent thrombosis, hemorrhagic transformation and hyperperfusion syndrome.

Disclosures K. Kim: None. K. Jang: None.