Introduction Carotid artery stenting (CAS) is an effective treatment for clinically significant carotid artery stenosis in selected patients. The increasing utilisation of endovascular management for acute ischaemic stroke has led to the use of CAS in the emergent setting for patients presenting with acute stroke and concomitant carotid artery stenosis. A variety of carotid artery stents are available and differ in material, shape and cell geometry. Microporous stents represent a new type of stent with significantly reduced cell size. We present a single-centre retrospective case series of emergent CAS (eCAS) procedures using a dual-layer micromesh nitinol stent in the acute stroke setting.
Materials and methods Ethics approval was granted by the institutional review board. Clinical data of all patients who underwent CAS using the Casper stent (Microvention, Terumo, Tustin, CA, USA) at a tertiary level 24-hour mechanical thrombectomy (MT) service over a two-year period (June 2016-June 2018) were retrospectively obtained and reviewed. Data collected included patient demographics, presenting symptoms, pre- and postprocedural National Institute of Health Stroke Scale (NIHSS) score, imaging findings including severity of stenosis or presence of tandem occlusion, use of intravenous thrombolysis (IV tPA) and/or antiplatelet agents, thrombectomy device and stents used, modified thrombolysis in cerebral infarction (mTICI) score and follow-up modified Rankin scale (mRS) data. Any complications were identified and categorised. All eCAS procedures were performed using the Casper dual-layer micromesh nitinol stent system.
Results Twenty eCAS procedures were performed in nineteen patients during this period. Patients received between 1 and 2 Casper stents of varying sizes. The majority of patients had tandem lesions (12/20; 60%) and carotid lesions were most commonly located in the proximal ICA (n=15; 75%). Median NIHSS score on admission was 17 (IQR 9–22). IV tPA was administered prior to six eCAS procedures (30%). Stent deployment was technically successful in all patients and was performed concurrently with MT in fifteen cases (75%). Recanalization rate was 95%. No intraprocedural complications occurred. Symptomatic intracranial haemorrhage (sICH) occurred in two patients (10%) and both resulted in death. No other procedure-related deaths occurred. Stent thrombosis occurred in two patients. No other stent-related complications occurred. Non-neurological complications included coagulopathy (3/20; 15%), hypotension (2/20; 10%), acute kidney injury (1/20; 5%) and aspiration pneumonia (1/20; 5%). Median NIHSS score at 24 hours postprocedure was 3 (IQR 1–12). Thirty-eight percent of patients had a good clinical outcome (modified Rankin scale between 0–2) at 3–6 month follow up.
Conclusion eCAS using the Casper stenting system is effective and technically feasible in patients presenting with acute stroke and concomitant carotid artery stenosis.
Disclosures A. Lamanna: None. J. Maingard: None. H. Kok: None. C. Barras: None. A. Jhamb: None. V. Thijs: None. R. Chandra: None. D. Brooks: None. H. Asadi: None.
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