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

Arturo Renú; Jordi Blasco; Carlos Laredo; Laura Llull; Xabier Urra; Victor Obach; Antonio López-Rueda; Salvatore Rudilosso; Federico Zarco; Elisabet González; José David Guio; Sergio Amaro; Angel Chamorro

doi:10.1016/j.atherosclerosis.2020.09.002

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

Atherosclerosis. 2020 Nov:313:8-13. doi: 10.1016/j.atherosclerosis.2020.09.002. Epub 2020 Sep 10.

Affiliations

¹ Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
² Radiology Department, Hospital Clinic, Barcelona, Spain.
³ Radiology Department, Hospital General Universitario, Ciudad Real, Spain.
⁴ Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain. Electronic address: samaro@clinic.cat.
⁵ Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain. Electronic address: achamorro@clinic.cat.

PMID: 33002751
DOI: 10.1016/j.atherosclerosis.2020.09.002

Abstract

Background and aims: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: Carotid lesion; Carotid stenting; Endovascular treatment; Ischemic stroke; Revascularization; Stent; Stent thrombosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain Ischemia* / diagnosis
Brain Ischemia* / epidemiology
Carotid Artery, Internal / diagnostic imaging
Carotid Artery, Internal / surgery
Carotid Stenosis* / diagnostic imaging
Carotid Stenosis* / epidemiology
Carotid Stenosis* / surgery
Endovascular Procedures* / adverse effects
Humans
Incidence
Ischemic Stroke*
Retrospective Studies
Stents
Stroke* / diagnosis
Stroke* / epidemiology
Treatment Outcome