Carotid stent occlusion after emergent stenting in acute ischemic stroke: Incidence, predictors and clinical relevance

• Published in: Atherosclerosis Vol. 313; pp. 8 - 13
• Main Authors: Renú, Arturo, Blasco, Jordi, Laredo, Carlos, Llull, Laura, Urra, Xabier, Obach, Victor, López-Rueda, Antonio, Rudilosso, Salvatore, Zarco, Federico, González, Elisabet, Guio, José David, Amaro, Sergio, Chamorro, Angel
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-11-2020
• Subjects: Carotid lesion; Carotid stenting; Endovascular treatment; Ischemic stroke; Revascularization; Stent; Stent thrombosis; Carotid stenting; Endovascular treatment; Carotid lesion; Ischemic stroke; Stent thrombosis; Stent; Revascularization
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2020.09.002

Emergent stent placement may be required during neurothrombectomy. Our aim was to investigate the incidence, predictors and clinical relevance of early extracranial carotid stent occlusion following neurothrombectomy.
We retrospectively analyzed a cohort of 761 consecutive neurothrombectomies performed at our center between May 2010 and August 2018, from whom a total of 106 patients had acute internal carotid artery occlusions. Early stent occlusion was defined as complete vessel occlusion within 24 h of neurothrombectomy. Clinical outcome was evaluated at day 90 with the modified Rankin Score scale (mRS). Pretreatment, procedural and outcome variables were recorded and analyzed using logistic regression.
Carotid stenting was performed in 99 (13%) patients. Of those, 22 (22%) had early stent occlusion at follow-up. Stent occlusion was associated with a lower use of post-stenting angioplasty [adjusted OR (aOR) = 11.2, 95%CI = 2.49–50.78, p = 0.002)], increased residual intrastent stenosis (aOR = 2.1, 95%CI = 1.38–3.06, p < 0.001) and unsuccesful intracranial recanalization (modified TICI score 0-2a) (aOR = 13.5, 95%CI = 1.97–92.24, p = 0.008). Stent occlusion was associated with poor clinical outcome at day 90 (poorer mRS shift, aOR = 3.9, 95%CI = 1.3–11.3, p = 0.014; mRS>2, aOR = 6.3, 95%CI = 1.8–22.7, p = 0.005), and with an increased rate of symptomatic intracranial hemorrhage at 24 h (14% versus 1%, p = 0.033).
Early carotid stent occlusion occurred in one out of five neurothrombectomies and was associated with periprocedural factors that included increased residual intrastent stenosis, a lower use of post-stenting angioplasty and unsuccessful intracranial recanalization. Further investigation is warranted for the evaluation of strategies aimed to prevent carotid stent occlusion.
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•Stent thrombosis occurs in one fifth of the patients treated with acute stenting.•Stent thrombosis is associated with specific procedural variables.•Stent thrombosis is associated with poor clinical outcome.•Further investigation of strategies aimed to prevent stent occlusion is needed.