Carotid artery stenting in acute stroke using a microporous stent device: a single centre experience.

Abstract

Carotid artery stenting (CAS) is an established treatment for carotid artery stenosis, typically in a semi-elective or elective setting. The growth of mechanical thrombectomy for acute stroke has led to an increased use of emergent carotid artery stenting (eCAS). This single-centre retrospective case series evaluates the safety and efficacy of eCAS using a dual-layer micromesh nitinol stent to treat carotid artery stenosis in the acute stroke setting. Ethics approval was granted by the institutional review board. Clinical data of all patients who underwent CAS using the Casper dual-layer micromesh nitinol stent system (Microvention, Terumo, Tustin, CA, USA) at a tertiary level 24-hour endovascular thrombectomy service over a two-year period (June 2016-June 2018) were retrospectively obtained and reviewed. Twenty eCAS procedures were performed in nineteen patients over the study period. Most patients had tandem lesions (12/20; 60%). Median NIHSS score on admission was 17 (IQR 9-22). Stent deployment was technically successful in all patients. Recanalization rate was 95%. Symptomatic intracranial haemorrhage occurred in two patients (10%), both resulting in death. No other procedure-related deaths occurred. Stent thrombosis occurred in two patients. One delayed embolic stroke occurred. No other stent-related complications occurred. Median NIHSS score at 24 hours postprocedure was 3 (IQR 1-12). Six patients had a good clinical outcome (modified Rankin scale between 0-2) at 3-6 month follow up (38%). eCAS using the Casper stenting system is effective and technically feasible in the acute stroke setting, although the ideal antiplatelet and anticoagulation regime is not clearly established.