Purpose To evaluate the occurrence and risk factors of acute in-stent thrombosis or stent occlusion in patients with tandem occlusions receiving intracranial mechanical thrombectomy and emergent extracranial internal carotid artery stenting with a dual layer carotid stent.
Methods Multicenter retrospective data collection and analysis of stroke databases of seven comprehensive stroke centers from three European countries.
Results Overall, 160 patients (mean (SD) age 66 (12) years; 104 men (65%); median (IQR) baseline NIHSS 14 (9–18); IV lysis, n=97 (60.6%)) were treated for a cervical carotid artery occlusion or stenosis using a CASPER stent (MicroVention), and received mechanical thrombectomy for an intracranial occlusion between April 2014 and November 2018. During the procedure or within 72 hours, formation of thrombus and complete occlusion of the CASPER stent was observed in 33/160 (20.8%) and in 12/160 patients (7.5%), respectively. In 25/33 (75.8%) and in 9/12 patients (75%), respectively, this occurred during the procedure. No statistically significant difference was observed between patients with and without thrombus formation with regard to pre-existing long term medication with anticoagulants or intraprocedural administration of heparin, acetylsalicylic acid (ASA), or heparin and ASA. Favorable early neurological outcome was similar in patients with (n=15; 45.5%) and without (n=63; 49.6%) thrombus formation at the CASPER stent.
Conclusion Acute thrombosis or occlusion of CASPER stents in thrombectomy patients receiving emergent extracranial internal carotid artery stenting for tandem occlusions were observed more often during the procedure than within 72 hours of follow-up, were less frequent then previously reported, and showed no impact on early neurological outcome.
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FW and MAM contributed equally.
Contributors JARP and MAM accept full responsibility for the finished article, had access to any data, and controlled the decision to publish. JARP, FW, and MAM were responsible for research design, data collection, data analysis and data interpretation, literature search, and writing and editing of the manuscript. CM, EB, HJ, RB, CD, VC, MP, FR, AB, MK-O, JTH, and MB helped with data collection, data interpretation, and writing and editing of the manuscript.
Funding This research was performed with departmental funding only. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests JARP: Activities related to the present article: none declared. Activities not related to the present article: travel and meeting expenses from Stryker and MicroVention. CM: Activities related to the present article: none declared. Activities not related to the present article: educational grant from Stryker and MicroVention. VC: Activities related to the present article: none declared. Activities not related to the present article: stock/stock options in Sim&Cure. MK-O: Activities related to the present article: none declared. Activities not related to the present article: grants from MicroVention. MB: Activities related to the present article: none declared. Activities not related to the present article: grants and personal fees from Bayer, Codman, Guerbet, Medtronic, and Novartis; grants from the Hopp Foundation, Siemens, and Stryker; personal fees from Braun, Böhringer Ingelheim, Roche, Teva, and Vascular Dynamics. FW: Activities related to the present article: none declared. Activities not related to the present article: consultancy for MicroVention, Cerenovus, and Route 92; payment for lectures from MicroVention, Bayer, and Daiichi Sankyo. MAM: Activities not related to the present article: board membership: Codman; consultancy: Medtronic, MicroVention, Stryker; grants/grants pending: Balt (money paid to the institution), MicroVention (money paid to the institution); payment for lectures includings service on speakers bureaus: Medtronic, MicroVention, and Stryker.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Individual participant data that underlie the results reported in this article (after deidentification) will be available to researchers who provide a methodologically sound proposal. Proposals should be directed to the corresponding author beginning 12 months and ending 36 months following article publication.
Patient consent for publication Not required.