Abstract

Background

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.

Methods

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.

Results

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(Is delay your implausible excuse to prevent attributing the stroke to stent placement?). 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%).

Conclusion

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.

Key Words

carotid artery atherosclerosis
carotid artery stenosis
carotid artery stenting
stroke
Casper stent
© 2019 Published by Elsevier Inc.